How To Use CPT Code 92312

CPT 92312 describes the prescription and fitting of contact lenses for patients who have undergone cataract surgery and are aphakic, meaning they have an absence of the lens of the eye. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 92312?

CPT 92312 can be used to describe the prescription and fitting of contact lenses for patients who have undergone cataract surgery and are aphakic. This code is specifically for corneal lenses for aphakia in both eyes.

2. Official Description

The official description of CPT code 92312 is: ‘Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, both eyes.’

3. Procedure

1. The provider assesses the patient’s optical and physical characteristics of the cornea to determine the appropriate contact lens prescription.
2. A corneal lens is selected or modified to suit the patient’s specific needs.
3. The provider fits the contact lenses for both eyes, ensuring proper adaptation and training of the wearer.
4. During the fitting process, the provider may make incidental revisions to the lenses to ensure optimal fit and vision correction.
5. The prescription and fitting of contact lenses for aphakia is a specialized service that requires the expertise of a medical provider, not a technician.

4. Qualifying circumstances

CPT 92312 is used for patients who have undergone cataract surgery and are aphakic, meaning they have an absence of the lens of the eye. This service is specifically for corneal lenses for aphakia in both eyes. It is important to note that the prescription and fitting of contact lenses is not considered part of general ophthalmic services and must be performed by a medical provider.

5. When to use CPT code 92312

CPT code 92312 should be used when prescribing and fitting corneal lenses for patients who have undergone cataract surgery and are aphakic in both eyes. This code is not appropriate for other vision abnormalities such as farsightedness, nearsightedness, astigmatism, or presbyopia. It is important to check with the patient’s insurance provider to determine coverage for contact lenses, as medical plans may vary in their coverage policies.

6. Documentation requirements

To support a claim for CPT 92312, the provider must document the following information:

• Diagnosis of aphakia resulting from cataract surgery
• Optical and physical characteristics of the cornea
• Date of the contact lens prescription and fitting
• Details of the fitting process and any revisions made to the lenses
• Training provided to the patient on lens adaptation
• Signature of the medical provider performing the service

7. Billing guidelines

When billing for CPT 92312, ensure that the service is performed by a medical provider and not a technician. It is important to follow the specific guidelines set by the patient’s insurance provider regarding coverage for contact lenses. Additionally, if the fitting is performed by an independent technician, different codes may apply. It is recommended to review the specific guidelines for these scenarios.

8. Historical information

CPT 92312 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient who has undergone cataract surgery in both eyes requires a corneal lens prescription and fitting to address their aphakia.
2. A medical provider assesses the optical and physical characteristics of the cornea and fits corneal lenses for a patient who is aphakic in both eyes.
3. After determining the appropriate contact lens prescription, a provider trains a patient with aphakia in both eyes on lens adaptation and ensures proper fitting.
4. A patient who has undergone cataract surgery in both eyes receives a prescription and fitting for corneal lenses to correct their vision.
5. A medical provider performs a comprehensive evaluation of a patient’s cornea and prescribes corneal lenses for aphakia in both eyes.
6. After cataract surgery, a patient requires a corneal lens prescription and fitting for both eyes to address their aphakia.
7. A provider fits corneal lenses for a patient who is aphakic in both eyes, ensuring proper adaptation and vision correction.
8. A patient with aphakia in both eyes receives a prescription and fitting for corneal lenses to improve their visual acuity.
9. Following cataract surgery, a medical provider prescribes and fits corneal lenses for a patient who is aphakic in both eyes.
10. A provider performs a detailed examination of a patient’s cornea and prescribes corneal lenses for aphakia in both eyes.