CPT® Code 92311

Official Description

Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, 1 eye

Common Language Description

The CPT® Code 92311 refers to the prescription and fitting of contact lenses specifically designed for patients with aphakia in one eye. Aphakia is a condition characterized by the absence of the eye's natural lens, often resulting from cataract surgery or congenital issues. In this procedure, the medical provider evaluates the patient's vision requirements and selects the most suitable contact lens options tailored to their specific needs. The provider discusses various types of contact lenses, including their advantages and disadvantages, to assist the patient in making an informed choice. The optical and physical characteristics of the chosen lenses, such as power, size, curvature, flexibility (whether hard or soft), and gas-permeability, are specified to ensure optimal visual correction and comfort. The provider then inserts the lenses and checks their fit, making necessary adjustments to enhance visual acuity and comfort. Additionally, the patient receives instructions on how to properly insert and remove the lenses, practicing under the provider's supervision. To ensure the best fit and vision, the patient may be given trial lenses from different manufacturers, allowing for adjustments to the lenses' characteristics during the trial period. All aspects of this procedure are conducted under the medical supervision of the provider, ensuring a comprehensive approach to the patient's visual rehabilitation.

1. Indications

The procedure associated with CPT® Code 92311 is indicated for patients who have aphakia in one eye. This condition may arise due to various reasons, including but not limited to cataract surgery or congenital absence of the lens. The fitting of contact lenses is essential for these patients to restore visual acuity and improve their quality of life.

Aphakia in one eye The primary indication for this procedure is the absence of the natural lens in one eye, necessitating the use of a contact lens to correct vision.

2. Procedure

The procedure begins with the medical provider assessing the patient's vision needs and discussing the available options for contact lenses. This includes evaluating the patient's lifestyle, preferences, and any specific visual requirements. The provider then selects the appropriate type of contact lens, taking into account various factors such as the optical power needed, the size and curvature of the lens, and whether the lens should be hard or soft, as well as its gas-permeability characteristics.

Selection of Contact Lenses The provider discusses the pros and cons of different contact lens types, ensuring the patient understands the implications of each choice. This collaborative decision-making process is crucial for achieving the best possible outcome for the patient's vision.
Fitting of Contact Lenses Once the lenses are selected, the provider inserts them into the patient's eye and checks the fit. This step is vital to ensure that the lenses provide optimal visual acuity and comfort. Adjustments may be made during this fitting process to enhance the overall experience for the patient.
Patient Education After fitting the lenses, the provider instructs the patient on how to properly insert and remove the lenses. This education is essential for the patient's independence and comfort in using the lenses. The patient practices these techniques under the provider's supervision to ensure proficiency.
Trial Period The patient may be given sample contact lenses from various manufacturers to try out over a specified period. This trial allows the patient to assess the comfort and effectiveness of the lenses in real-life situations. During this time, incidental revisions to the optical and physical characteristics of the lenses may be made to further improve visual acuity or comfort.

3. Post-Procedure

Post-procedure care involves monitoring the patient's adaptation to the contact lenses. The provider may schedule follow-up appointments to assess the fit and comfort of the lenses, making any necessary adjustments. The patient is encouraged to report any discomfort or vision issues that arise during the trial period. Proper hygiene and care instructions for the lenses are emphasized to prevent complications such as infections or lens damage. Overall, the goal of post-procedure care is to ensure that the patient achieves the best possible visual outcome and comfort with their new contact lenses.

Short Descr	CONTACT LENS FITG APHAKIA 1
Medium Descr	RX&FITG CONTACT LENS CORNEAL LENS APHAKIA 1 EYE
Long Descr	Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, 1 eye
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	STV-Packaged Codes
Type of Service (TOS)	Q - Vision Items or Services
Berenson-Eggers TOS (BETOS)	M5C - Specialist - ophthalmology
MUE	1
CCS Clinical Classification	220 - Ophthalmologic and otologic diagnosis and treatment

LT	Left side (used to identify procedures performed on the left side of the body)
26	Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
52	Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
CR	Catastrophe/disaster related
KX	Requirements specified in the medical policy have been met
RT	Right side (used to identify procedures performed on the right side of the body)
SC	Medically necessary service or supply