SEP 12, 2016
Denial for Fitting of Bandage Contact Lens
Question: Our practice keeps receiving denials for the fitting of bandage contact lens. We submit CPT codes 99213 -25, 65435 –RT Removal of corneal epithelium and 92071 –RT Bandage contact lens fitting for these services. Medicare keeps paying the exam and procedure only.
Answer: According to CCI edits that took effect April 1, 2013, CMS bundles the fitting of the bandage lens into the surgery. You cannot separately bill for it. For future reference you can access CCI edits at aao.org/coding or in both the print and online Coding Coach Complete Ophthalmic Reference. Be sure that the established-patient exam is significant and separately identifiable from the minor procedure performed the same day. Verify this statement to determine if you should bill the exam with modifier -25: While medically necessary, if the physician performs the established-patient exam solely to confirm the need for the minor procedure, you cannot separately bill for it.