How To Use CPT Code 92072

CPT 92072 is a code used for the initial fitting of contact lenses to manage keratoconus, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 92072?

CPT 92072 is a medical billing code used to describe the initial fitting of contact lenses for the management of keratoconus. This code is utilized by medical professionals to bill for the service of fitting a patient with contact lenses specifically designed to treat keratoconus, a progressive eye condition that causes the cornea to thin and bulge into a cone-like shape.

2. 92072 CPT code description

The official description of CPT code 92072 is: “Fitting of contact lens for management of keratoconus, initial fitting.”

3. Procedure

1. The patient is prepped and anesthetized as necessary.
2. The provider evaluates the cornea for keratoconus.
3. A soft contact lens of the correct size is selected by the provider.
4. The contact lens is applied over the cornea by the provider.
5. The provider evaluates the lens using a slit lamp to ensure proper fit and function.

4. Qualifying circumstances

Patients eligible to receive CPT code 92072 services are those diagnosed with keratoconus and require the initial fitting of contact lenses specifically designed to manage this condition. The provider must determine that contact lenses are the most appropriate treatment option for the patient’s keratoconus, considering factors such as the severity of the condition, the patient’s overall eye health, and their ability to tolerate contact lenses.

5. When to use CPT code 92072

It is appropriate to bill the 92072 CPT code when a provider performs the initial fitting of contact lenses for the management of keratoconus. This code should not be used for subsequent fittings or for the fitting of contact lenses for other ocular conditions. In those cases, other CPT codes may apply.

6. Documentation requirements

To support a claim for CPT 92072, the following information should be documented in the patient’s medical record:

• A diagnosis of keratoconus
• A detailed description of the fitting procedure, including the type and size of the contact lens used
• Results of the slit lamp evaluation, confirming the proper fit and function of the contact lens
• A statement indicating that the contact lens fitting is for the management of keratoconus and not for other ocular conditions
• Any relevant follow-up care instructions or recommendations

7. Billing guidelines

When billing for CPT code 92072, it is important to follow the appropriate guidelines and rules. Do not report 92072 in conjunction with 92071, which is used for the fitting of contact lenses for the treatment of ocular surface disease. Additionally, the supply of the contact lens should be reported separately using 99070 or the appropriate supply code. For subsequent fittings, evaluation and management services or general ophthalmological services codes should be used instead of 92072.

8. Historical information

CPT 92072 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Similar codes to CPT 92072

Five similar codes to CPT 92072 and how they differentiate are:

• CPT 92071: This code is used for the fitting of contact lenses for the treatment of ocular surface disease, not keratoconus.
• CPT 92310: This code is used for the prescription of optical and physical characteristics of and fitting of contact lenses, including materials for and fabrication of custom-made lenses.
• CPT 92311: This code is used for the prescription of optical and physical characteristics of and fitting of contact lenses for aphakia, including materials for and fabrication of custom-made lenses.
• CPT 92312: This code is used for the prescription of optical and physical characteristics of and fitting of contact lenses for presbyopia, including materials for and fabrication of custom-made lenses.
• CPT 92313: This code is used for the prescription of optical and physical characteristics of and fitting of contact lenses for myopia, hyperopia, or astigmatism, including materials for and fabrication of custom-made lenses.

10. Examples

Here are 10 detailed examples of CPT code 92072 procedures:

1. A patient with newly diagnosed keratoconus undergoes an initial fitting of contact lenses to manage the condition.
2. A patient with progressive keratoconus requires a change in contact lens type and undergoes an initial fitting of the new lenses.
3. A patient with keratoconus who has never worn contact lenses before is fitted with lenses specifically designed to manage their condition.
4. A patient with keratoconus who has previously worn glasses is fitted with contact lenses for the first time to better manage their condition.
5. A patient with keratoconus undergoes an initial fitting of contact lenses after corneal cross-linking surgery.
6. A patient with keratoconus who has been using rigid gas permeable lenses is fitted with soft contact lenses for the first time.
7. A patient with keratoconus undergoes an initial fitting of contact lenses after a corneal transplant.
8. A patient with keratoconus who has been using hybrid lenses is fitted with scleral lenses for the first time.
9. A patient with keratoconus undergoes an initial fitting of contact lenses after a change in their corneal topography.
10. A patient with keratoconus who has been using piggyback lenses is fitted with custom-made soft contact lenses for the first time.