Dr. Newman provides a very contemporary overview of modern billing and coding of specialty contact lenses today that incorporates recent third party changes. The course objective is to discuss methods for coding and billing for medically necessary contact lenses and for incorporating ICD-10-CM into medically necessary contact lens prescribing. His presentation included the following:

1) Definitions of Health Care Services

2) Covered Versus Non-covered Services

3) Documentation of medical necessity

4) Guidance Materials (web-based resources)

5) Establishing the Diagnostic Code Set

6) Understanding CPT Codes and Code Modifiers (what codes are important including material and procedural)

7) Advanced Beneficiary Notification (ABN) Modifiers

8) Codes for Contact Lens Services (all forms of lenses, materials, conditions including keratoconus, and unlisted codes)

9) Guidance on the 92072 “Initial Fitting” Code

10) Patient Management Issues

• Have staff confirm eligibility and reimbursements prior to visit
• Match appropriate ICD-10-CM diagnostic codes to the appropriate CPT and HCPCS service codes
• Use a patient brochure to explain the process (available at www.gpli.info in the coding and billing module)
• Send letters of medical necessity when needed (templates are available at www.gpli.info in the coding and billing module)

11) Documentation

12) Clinical Examples

• Keratoconus, unstable, right eye: includes billing codes and amounts
• Crosslinking patient

13) Vision Care Plan MNCL Benefits

• Vision Service Plan® (VSP); Eyemed®; United Healthcare®/Spectera®; Versant Health™ (Superior Vision™ & Davis Vision™); Vision Benefits of America (VBA)
• A review of each plan and how to be successful with each of these plans and their individual differences is presented

14) Conclusions

• Be consistent
• Have the right tools; know where to find the information
• You decide what tests and procedures need to be performed; the third party plan decides what they will pay for
• Communicate with your patients
• Don’t be afraid to appeal rejections or send third party payers to collection

SPOTLIGHT ON EDUCATION PART II:

"Management of Contact Lens Complications"

Dr. Joseph Shovlin

Dr. Shovlin focused on three areas in his presentation which was very well illustrated with excellent photos and graphics of the conditions discussed as well as the results of the peer-reviewed literature.

1) The Dry Eye Dilemma: Contact Lens-Induced Dry Eye, Lid Wiper Epitheliopathy, Meibomian Gland Dysfunction, and Dry Eye Masquerades

• Self-reported dry eye disease
• Frequency of factors associated with contact lens dissatisfaction and discontinuation
• Treatments aimed at local inflammatory processes
• Discussion and management of LWE, MGD, and dry eye masquerades; the latter includes recurrent corneal erosion, filamentary keratitis, blepharitis/MGD, Mucous Fishing Syndrome, Floppy Eyelid Syndrome/Giant Fornix Syndrome, Conjunctivochalasis, Salzmann Nodular Degeneration

2) Cornea and Conjunctival Fascinations: Dendritiform Lesions, Superior Limbic Keratoconjunctivitis, and Stem Cell Dysfunction

• This included a comprehensive overview of these conditions along with their diagnosis and management
• Contact lens-induced corneal staining
• An emphasis on Stem Cell Dysfunction and recent literature, diagnosis, and management

3) Corneal Infiltrates: Sterile Responses vs. Microbial Keratitis

• Results of Microbial Keratitis Think Tank: a forum at the Annual Meeting of the American Academy of Optometry (1)
• Factors associated with corneal infiltrative events
• Organisms associated with mild keratitis, keratitis with focal infiltrate, and corneal ulcer
• Incidence of contact lens-induced corneal ulcer
• Modifiable and non-modifiable risk factors
• Management

References:

1. Szczotka-Flynn LB, Shovlin JP, Schnider CM, et al. American Academy of Optometry Microbial Keratitis Think Tank. Optom Vis Sci 2001;98(3):182-198.