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Confusion reigns with new codes for therapeutic contact lenses

May 8, 2012

Edited by Chuck Brownlow, O.D., Medical Records consultant

Effective Jan. 1, 2012, Current Procedural Terminology (CPT© American Medical Association) deleted 92070, the code that has been used for years to report the fitting and supply of a bandage contact lens.

Code 92070 has been replaced by two new codes:

  • 92071, fitting of contact lens for treatment of ocular surface disease, and
  • 92072, fitting of contact lens for management of keratoconus, initial fitting

CPT has made it clear, both in CPT Assistant and CPT Changes: An Insider’s View 2012, that the new codes are meant to be used for reporting the fitting of the lens only and that neither code includes the supply of the lens.

CPT offers additional notes for the new codes, including “(Do not report 92071 in conjunction with 92072)” and “(Report supply of lens separately with 99070 or appropriate supply code).”

Because 99070, supply of materials, is commonly rejected by Medicare carriers and some other insurers, it may be wise to use “appropriate supply codes” to report the supply of the contact lens in combination with 92071 and 92072.

The only “supply codes” we know of are the V codes, V25XX, in the CMS Healthcare Common Procedure Coding System (HCPCS).

We know some insurers have followed that logic and consider the HCPCS codes to be appropriate, though apparently others have not.

Several challenges have arisen with respect to insurers’ handling of the new codes:

1. Some insurers have not changed their internal listings of CPT codes to include 92071 or 92072 and are requiring bandage lenses be reported using the deleted code, 92070. We assume this issue is self-limiting and all carriers will eventually begin using the new codes.

2. Some insurers, including some Medicare carriers, are treating the new codes as they did 92070 and consider the supply of the lens to be included in the reimbursement for 92071 and 92072.

3. Medicare and some other insurers never reimburse for 99070, supply of materials, making it fruitless to bill 99070 in combination with either 92071 or 92072.

4. Some Medicare carriers view all HCPCS codes (and possibly other supply codes) as being covered by Medicare’s Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), rather than by Part B Medicare; yet we have not heard of any doctor being successful in receiving payment from DMEPOS for a bandage contact lens.

5. Some insurers do not consider keratoconus to be a medical condition and thus will reject any claim for 92072, with or without materials, due to the diagnosis.
AOA volunteers and staff have been busy trying to identify solutions to all of these challenges.

  • Hopefully #1 and #2 will be solved as the offending insurers are snapped into the reality that CPT codes change each year, which will lead to their quietly making updates to their internal list of approved codes, and applying the definitions of the new codes in their consideration of claims.
  • #3 and #4 will require additional work by representatives of the AOA and the American Academy of Ophthalmology to get additional clarification from CPT as to what they had in mind with “appropriate supply codes” and to then distribute that information to their members.
  • #5 has been an ongoing challenge for decades and the efforts to get insurers to recognize keratoconus as a medical condition, not a contact lens issue, are ongoing.

The role of the AOA is pretty well defined as these new codes gain wider use, and progress in those efforts will continue to be reported in the appropriate AOA media.

It’s also important that all AOA members and members’ staff consider themselves to be involved in the problem-solving process as well.

Please take action whenever you find an insurer that seems to not realize codes have changed or seems to be using or rejecting codes in ways that are not consistent with the official CPT definitions.

Your actions should include:

  • Contact the insurer to inquire as to why they are not recognizing a new code or why they are not honoring the code’s definition in considering claims.
  • Contact your state association to see if other doctors and staff are experiencing the same issues.
  • Contact the AOA through your state third-party committee, or directly through askthecodingexpert@aoa.org.

We are confident each of these challenges will be resolved, some early in 2012 and some later, realizing that it will require a team effort of the AOA, the state associations, as well as members and staff making the grassroots efforts in direct contact with the insurers.

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