4 coding conundrums clarified

September 12, 2018
The AOA’s Coding Experts offer answers to frequently asked questions.
The AOA’s Coding Experts offer answers to frequently asked questions.

Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D.

Excerpted from page 41 of the July/August 2018 edition of AOA Focus.

Has coding got you stumped? Worry no more—the AOA's Coding Experts offer answers to frequently asked questions.

At what point after the initial fitting of a keratoconus lens (92072) is a new lens (not a replacement) billable with code 92072, due to the fact that the lens no longer fits the patient's need?

According to the CPT Assistant, code 92072, fitting of contact lens for management of keratoconus, initial fitting, is reported for initial fittings only. The description of work for initial fittings includes the results of diagnostic tests done prior to contact lens fitting to assess the corneal ectasia, which are used in concert with slit lamp examination to assess corneal shape and determine initial contact lens parameters (e.g., diameter, base curve and secondary curves). Lens designs can include corneal, scleral, hybrid, or piggyback systems. Keratometry, lid anatomy, tear film and refraction are also performed and/or rechecked. If the lens needs to be changed because it no longer fits the patient's needs, the fitting of a new lens is considered an initial fitting and should include all of the services noted above.

Should H43.399 other vitreous opacities, unspecified eye, be billed to Medicare annually for retinal photos if they remain unchanged?

It is best to avoid unspecified under all circumstances regardless of the tissue in question. Additionally, there is no justification for billing retinal photographs to Medicare unless there is some change to document.

What is the primary code used for dry eye?

H04.123: Dry eye syndrome of bilateral lacrimal gland.

Where can I find guidance on billing for vision therapy?

Access the AOA's updated guidance.

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