Optometric Billing-Billing for Contact Lens Training

When doing my usual look up of site stats for The Optometric Billing spot today, I noticed that someone Googled us using the following key word: "can you bill for contact lense training" . 

I was a bit baffled by this considering that this is historically considered part of the contact lens fitting but I figured I would look 
it up for you cause it piqued my interest. So, here is what I came up with. NO, YOU CAN NOT SPECIFICALLY BILL SEPARATELY FOR 
THE TRAINING. The one area where you might be able to get away with it is insurance companies that take "S" codes
as there is an "s" code for Comprehensive Contact Lens Evaluation. However, I doubt the reimbursement is even worth your time.
I also doubt that insurance company would let you bill for both a Contact lens fitting (92310) and the Comprehensive Evaluation
(S0592) for the same patient, but maybe someone better than I can figure that out for you. 

Bottom line, as always in the Medical Vs. Insurance world....Play it safe and don't get greedy!

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Optometric Billing-92072-Fitting of Contact Lens for Keratoconus-V2531

Admittedly this post should have been made in January of 2012 however, we are putting it up now because we have noticed large search traffic coming to our site specifically for the term "Keratoconus, Contact Lens"

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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For help with optometric billing in your practice, contact opticXpress today!