Ophthalmology is a sensitive medical specialty because the eyes are the most delicate part of the body. Applying contact lenses can sometimes feel more complex than surgery. The same is true for their billing. Although CPT code 92310 is frequently billed for fitting contact lenses, even small changes and slight errors can lead to revenue loss.
But now you don’t have to worry anymore! We have compiled this guide on CPT code 92310 to increase claim accuracy and reduce denials. Whether you’re an ophthalmologist, optometrist, or part of the billing team, this guide is for you. So, let’s start.
CPT Code 92310 – Description
CPT code 92310 is described as:
“Prescription of optical and physical properties, fitting of contact lenses (corneal lens), and medical supervision of adaptation for both eyes, except for aphakia.”
Was it challenging to comprehend? Here is a simple breakdown. This code covers the assessment and fitting of contact lenses. But there is more to it. The code also covers the initial fitting and subsequent care required to ensure the contact lens is appropriate for the patient’s vision correction requirements and eye health.
Optometrists and ophthalmologists frequently bill CPT code 92310 for professional services related to evaluating the contact lens fit, teaching the patient how to wear them properly, and making the necessary modifications to maximize comfort and vision. You can bill this code for fitting any corneal lenses, including standard soft contact lenses, custom soft lenses, soft toric lenses, soft multifocal lenses, corneal GP lenses, intralimbal lenses, and hybrid lenses.
Appropriate Use Cases for CPT Code 92310
Here are some real-life scenarios that further explain the description of the CPT code 92310.
Initial Use of Contact Lens
Suppose a 20-year-old college student has been nearsighted since childhood and has worn glasses. She now wants to switch to contact lenses to participate in sports and social events more conveniently. The optometrist starts by measuring her corneas and choosing the right lens power. He then fits trial lenses and instructs her on how to put them on and take them off.
The service provider also arranges a follow-up appointment to check her contact lens adaptation.
CPT code 92310 is correctly reported because the service entails professional fitting and management of contact lenses for both eyes.
Application of New Contact Lenses
Suppose a 30-year-old man has been wearing contact lenses for five years. When he visits an optometrist for a yearly examination, the optometrist notices a drastic change in his prescription. His current lenses are no longer providing the best vision correction.
Now, the eye specialist acquires new corneal measurements and fits trial lenses. The provider may bill CPT code 92310 for the full prescription and refitting service.
Modifiers to Append with CPT Code 92310
The claims for CPT code 92310 must include the following applicable modifiers, according to the services rendered.
Modifier 52
CPT code 92310 refers to the services of both eyes. If the provider is performing services on one eye, you must bill services with modifier 52 (which reports reduced services).
Modifiers LT and RT
Once you have appended the modifier 52, then you can apply modifier LT or RT to indicate that the services were performed at the left or right eye when payer policies require laterality reporting.
Reimbursement Guidelines for CPT Code 92310
Follow these billing guidelines to accurately bill services with CPT code 92310.
Maintain Complete Documentation
Ensure that you have accurately reported your services with all the necessary information needed for claim approval and audit compliance when submitting the claim to the payer.
Your claim for CPT code 92310 should include:
- The patient’s history
- Comprehensive corneal measurements
- Lens type and specifications
- Appropriate justification and clinical decision-making procedure
- Instructions for insertion, removal, and care that were given to the patient
- Monitoring strategy for adaptation and follow-up schedule
- Follow-up care notes
- Any issues or modifications made throughout the fitting procedure
Verify Insurance Coverage
Before providing contact lens fitting services, providers must verify if the patient’s insurance plan covers these services.
Medicare usually considers it a non-medical visual or cosmetic service rather than a medically essential treatment and does not reimburse. But many vision plans offer benefits for contact lens fittings, while traditional medical insurance generally does not cover routine contact lens fitting services unless medical necessity is established.
However, there are situations where contact lenses are recommended for certain medical conditions, such as:
- Lack of a natural lens, or aphakia
- Refractive errors
- Corneal abnormalities following surgery
Summing It Up
CPT code 92310 is an ophthalmology billing code used to collect reimbursement for contact lens prescription and fitting. Eye care specialists can reduce their denial rate by using this comprehensive guide on code 92310.
If you are managing your optometry practice alone and dealing with patients and their documentation, learning the secrets of billing and coding may determine the stability of cash flow. Moreover, if you are regularly receiving denials or require help managing the complexities of billing, you can use expert ophthalmology billing services and experience the difference.
