icd 10 code for fitting of aphakic contact lens

What is the CPT code for aphakic contact lens fit?

Keep in mind that this service is separate from any evaluation and management services or general ophthalmological services, which should be reported using the appropriate code (99000 or 92000 series) if that level of service was performed and met. The codes for aphakic contact lens fits are either 92311 (for one eye) or 92312 (for both eyes).

What is the ICD 10 code for contact lens fitting?

Use this code when you are fitting soft contact lenses or corneal GP lenses, unless the patient has aphakia. This is a bilateral code, so you would only bill this code once, even if you fit both eyes. 92311 Contact lens fitting of a corneal lens for aphakia, one eye.

What is the CPT code for hydrophilic contact lenses?

V2523 Contact Lens, Hydrophilic, Extended Wear, Per Lens Use this code when the contact lens is made of a high-Dk material or when your patients are sleeping in their contact lenses. V2531 Contact Lens, GP, Scleral, Per Lens Use this code when fitting scleral lenses (including corneo-scleral, mini-scleral, or full scleral).

What type of contact lenses can I use with aphakia?

This would include soft contact lenses, corneal GP lenses, intralimbal lenses, and, in some cases, hybrid lenses and custom soft lenses. Use this code when you are fitting aphakia in one eye only with a corneal lens. Use this code when you are fitting aphakia in both eyes with a corneal lens.

How do I bill my contact lens fitting?

Use CPT 92310, which is defined as: “Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia.” Note that CPT 92310 is for both eyes.

How do you code medically necessary contacts?

Use this code when you are fitting aphakia in one eye only with a corneal lens. Use this code when you are fitting aphakia in both eyes with a corneal lens....WHAT QUALIFIES AS A MEDICALLY NECESSARY CONTACT LENS?CODEDESCRIPTIONV2510Contact Lens, GP, Spherical, Per LensV2511Contact Lens, GP, Toric, Per Lens10 more rows•Feb 1, 2020

What is the modifier for medically necessary contacts?

Modifiers GA and GZ are often used if a procedure does not meet medical necessity as determined by a Medicare Local Coverage Determination or National Coverage Determination.

What is the ICD 10 code for contact lenses?

Presence of spectacles and contact lenses Z97. 3 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z97. 3 became effective on October 1, 2021.

Does Medicare cover contact lenses for aphakia?

Medicare and Contact Lenses Medicare covers contact lenses only for aphakic patients or those who suffer from a corneal disease such as keratoconus. Medicare requires that you bill the contact lens services and materials separately. In the case of aphakia, use 92311 if you fit one eye and 92312 if you fit both eyes.

What is an aphakic eye?

10, 2021. Aphakia means not having a lens inside your eye. The lens is the clear, oval-shaped structure behind the iris (colored part of your eye) and pupil. It focuses light rays on the retina. Without a lens, the eye is out of focus and vision is blurry.

Does medical cover contact lens fitting?

Contact Lens Examination In addition to the basic eye examination, a contact lens fitting is reimbursable with CPT® codes 92071, 92072 and 92310 thru 92312 for recipients with medically necessary conditions.

What is the difference between medically necessary and elective contacts?

Medically necessary contact lenses are non-elective contact lenses prescribed when certain medical conditions hinder vision correction through regular eyeglasses and contact lenses are the accepted standard of treatment.

Does Medicare cover medically necessary contact lens?

While Medicare covers some vision services, it doesn't usually pay for eye exams or contact lenses. Some of the vision services original Medicare (parts A and B) may cover include: annual glaucoma test for people at high risk (including those with diabetes or a family history of glaucoma)

What is diagnosis code H52 13?

ICD-10 code H52. 13 for Myopia, bilateral is a medical classification as listed by WHO under the range - Diseases of the eye and adnexa .

What is CPT V2510?

V2510 is a valid 2022 HCPCS code for Contact lens, gas permeable, spherical, per lens or just “Cntct gas permeable sphericl” for short, used in Vision items or services.

What is code V2520?

HCPCS code V2520 for Contact lens, hydrophilic, spherical, per lens as maintained by CMS falls under Assorted Contact Lenses .

What is the code for aphakic contact lenses?

The codes for aphakic contact lens fits are either 92311 (for one eye) or 92312 (for both eyes). CPT defines these as: 1. 92311: “Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, one eye.”. 92312: “Prescription of optical ...

What is CPT 92310?

Use CPT 92310, which is defined as: “Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia.” 1. Note that CPT 92310 is for both eyes.

What is 92072?

92072: Fitting of contact lens for management of keratoconus, initial fitting only. Unfortunately, not every medical insurance carrier will pay for these codes. So, contact the patient’s medical insurer in advance to determine what, if anything, they will pay for before proceeding.

What modifier do you use for only one eye?

If you’re prescribing and fitting for only one eye, add modifier -52 (for “reduced services”). In addition, because “elective contact lenses” may be a covered benefit by your refractive carriers, it’s vital that you understand what your obligations are under your contract. 3.

Do contact lens wearers need more time?

Contact lens wearers do require more time and follow-up; that additional service is worth something. When setting the various levels of fees, it is important to consider whether it’s an established contact lens patient, a first-time multifocal wearer or a newly-diagnosed keratoconic patient.

What is the ICd 10 code for corneal transplant?

An example may look like this: 1 Jane Doe, 1-1-2001, ID# 1234, Plan XYZ 2 Diagnosis: corneal transplant status, ICD 10 code Z94.7 3 CPT code (s): 92310 (Prescription of Optical and Physical Characteristics of and Fitting of Contact Lens, with Medical Supervision of Adaptation; Corneal Lens, Both Eyes, Except for Aphakia) 4 V code (s): V2511-RT and V2511-LT (contact lens, GP, toric, per lens) 5 Usual and customary rate: $500 for 92310, $250 for V2511-RT, and $250 for V2511-LT 6 Patient has met his or her deductible in full; the co-pay for medically necessary contact lens services and materials is $25 7 The expected reimbursement from the insurance based on diagnosis code, CPT code, V codes, and allowed amounts is $400 total, according to Mary at Insurance Company A.

How to bill specialty lenses?

Step 1 The first step for specialty lens billing is to contact a patient’s insurance (vision and/or medical) and obtain a prior authorization for medically necessary contact lens coverage. This may not occur until after you see patients, so often it cannot be done prior to their appointment.

What is the insurance code for contact lens fitting?

Most vision insurances are billed this way. They usually accept a contact lens fitting code (9231X) as one fee, then the V codes as another fee.

What is balance billing in insurance?

Balance billing means that it is acceptable to bill the remaining difference to the patient; in this case, the U+C is $1,000 and the insurance payment is $400, so the difference would be $600.

What is billing and coding?

Billing and coding are a source of frustration for both practitioners and patients. Reimbursement methods and rates vary drastically between carriers and even sometimes between patients. Often, it is difficult to obtain a clear answer on what the proper method is, what codes to use, and how to determine coverage.

Do you need prior authorization for contact lenses?

This is very typical, and each insurance has a different contracted rate. This is why it is so important to obtain prior authorizations before fitting medically necessary lenses. As the practitioner, you should be fully aware of the expected reimbursement prior to initiating any contact lens fitting.

What is the code for a corneal lens fitting?

92312 Contact lens fitting of a corneal lens for aphakia, both eyes. Use this code if you are fitting a soft contact lens or corneal GP lens for a patient who has aphakia if you are fitting both eyes. 92313 Contact lens fitting of a corneoscleral lens, both eyes.

What is the V2531 code?

V2531 Contact Lens, GP, Scleral, Per Lens Use this code when fitting scleral lenses (including corneo-scleral, mini-scleral, or full scleral). Do not use V2530, which is a scleral lens that is gas-impermeable.

What is level 2 99000?

Typically, level 2 and 3 99000 codes are used for billing services to insurance.

Can you use soft lenses for bandage?

When fitting soft lenses for bandage lens use, there can always be concern pertaining to the risk of infection and other complications. Off-label use for longer wearing periods including daily disposable lenses also increases potential risk. However, in some cases, the benefits clearly outweigh the risks. Additionally, informed consent and access to emergency care, if necessary, adequately address the medicolegal concerns.

Does insurance cover eyeprints?

As most insurance companies will not cover the EyePrint Prosthetic, an Advanced Beneficiary Notice (ABN) is signed by all patients who elect to receive this procedure. A written contract outlining the fees along with global period, etc. should be signed by each patient as well.

Does each insurance company have its own specifications?

While similar, each insurance company has its own specifications when it comes to submitting claims. The following case studies will look at patients who have various conditions and who have different vision insurance, and it will examine how to code and bill these eyecare situations.