That being Said, we bill for this procedure at Stowe Eyecare using a blend of guidance from EyeCOR and an article written by Gregory W. DeNaeyer, O.D., F.A.A.O, for optometricmanagement.com .When billed properly, most medical plans will cover not only the fitting but the actual materials/supplies as well. NOTE: IT IS EXTREMELY IMPORTANT THAT YOU CO-ORDINATE YOUR CARE WITH THE PATIENT'S INSURANCE AND VERIFY COVERAGE BEFORE YOU GO AHEAD WITH THE PROCEDURE AS IT CAN UNDOUBTEDLY COST THE PATIENT ALOT OF MONEY OUT-OF-POCKET. NOW THAT THE AFFORDABLE CARE ACT IS IN HIGHER EFFECT, MANY PATIENTS THAT YOU PERFORM THIS PROCEDURE ON WILL HAVE HIGH-DEDUCTIBLE PLANS SO, EVEN THOUGH IT IS COVERED, THEY WILL STILL HAVE TO PAY FOR IT.
The proper code for the actual initial fit of a Keratoconus Scleral Lens is 92072 and is either UNILATERAL or BILATERAL with potential modifiers being RT, LT, or 50 (I do not like using the 50 modifier for ANY bilateral procedure but that is admittedly a personal bias on my part).
EyeCOR Note: "This procedure code is new as of January 2012.
This procedure does NOT include the supply of lens. Use the appropriate V-code to separately report the materials.
To report subsequent visits, use 992xx or 920xx exam code."
You can then bill the insurance company for lenses themselves on the same day using V2531. Again, the materials are either Unilateral or Bilateral depending on the actual fit itself. (Another personal bias and GOOD CODING HABBIT: Always list exam procedures on a claim BEFORE materials. It's less messy looking, more precise and it actually does give your claims a chance at getting paid properly the first time, without human intervention at the insurance company.)
Claim Example:
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