Print | ShareCPT Code: 92072 Region: 37
States covered: General guidelines if your state does not have a local coverage determination
Title: Fitting of a Contact Lens for the Management of Keratoconus, Initial Visit
Category
Special Ophthalmological Services
Description
CPT Code 92072 is the fitting of contact lens for management of keratoconus; initial fitting.
This Medicare carrier does not have a local coverage determination (LCD) for treating keratoconus with contact lenses. The policy presented is a sample and is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.
CPT Code 92072 is the fitting of contact lens for management of keratoconus; initial fitting. This definition covers the fitting of a prescriptive or nonprescriptive contact lens to treat keratoconus in order to reshape the cornea to correct the patient’s vision.
Keratoconus is a disorder of the anterior surface of the eye (the cornea). In simple terms, the cornea becomes thinner causing it to bulge from its normal round shape to a cone shape. This bulging interferes with a person’s vision and can severely affect the way they see the world, making simple tasks like reading, watching TV or driving very difficult. The distortion caused by keratoconus has been compared to viewing a street sign through your car windshield during a driving rainstorm.
The progression of keratoconus is unpredictable, but generally the condition progresses slowly and can cease at any stage. While keratoconus interferes with the clarity of a person’s sight it rarely causes blindness. In its early stages, keratoconus causes slight blurring and distortion of vision and increased sensitivity to glare and light. As the disorder progresses, the degree of vision obtained through glasses becomes less acceptable and contact lenses often become the best method of correcting vision problems.
Most people can successfully manager their condition using special keratoconus contact lenses, however in a small number of cases where the cornea can no longer successfully be fitted with contact lenses, a corneal transplant may be needed.
ICD-10 Diagnosis Codes
| ICD-10 Code | Description |
|---|---|
| H18.601 | Keratoconus, unspecified, right eye |
| H18.602 | Keratoconus, unspecified, left eye |
| H18.603 | Keratoconus, unspecified, bilateral |
| H18.611 | Keratoconus, stable, right eye |
| H18.612 | Keratoconus, stable, left eye |
| H18.613 | Keratoconus, stable, bilateral |
| H18.621 | Keratoconus, unstable, right eye |
| H18.622 | Keratoconus, unstable, left eye |
| H18.623 | Keratoconus, unstable, bilateral |
1. The medical record should clearly indicate the condition being evaluated and the primary diagnosis must support the medical necessity of the testing.
2. Documentation must be available to Medicare upon request.
1. Report fitting of contact lens for management of keratoconus; initial fitting, with CPT code 92072.
2. This is a unilateral service, therefore the -RT or -LT modifiers must be utilized if only one eye is being treated and a unit of “1” is placed in the unit field of the CMS 1500 form or its electronic equivalent.
3. If both eyes are treated, no modifiers are required and a unit of “2” is placed in the unit filed of the CMS 1500 form or its electronic equivalent.
4. An eye examination may be reported on the same day as a fitting of contact lens for management of keratoconus if it is medically necessary.
5. Do not report 92072 in conjunction with 92071.
6. Any subsequent fittings should be reported using either Evaluation & Management codes or Ophthalmological codes.
There are no specific utilization guidelines for fitting of contact lens for management of keratoconus, however, CPT code 92072 is for an initial fitting and should only be used once per patient.