CPT® Code 92313

Official Description

Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneoscleral lens

Common Language Description

The CPT® Code 92313 refers to the prescription and fitting of corneoscleral contact lenses, which are specialized lenses designed to cover both the cornea and a portion of the sclera (the white part of the eye). This procedure involves a comprehensive assessment of the patient's vision needs, where the medical provider evaluates various contact lens options tailored to the individual's requirements. The provider discusses the advantages and disadvantages of different types of contact lenses, ensuring that the patient is well-informed about their choices. The optical and physical characteristics of the selected lenses are specified, including important factors such as lens power, size, curvature, flexibility (whether the lens is hard or soft), and gas-permeability, which affects the lens's ability to allow oxygen to reach the eye. During the fitting process, the provider inserts the chosen lenses and checks their fit to ensure optimal visual acuity and comfort. If necessary, adjustments are made to enhance the patient's experience. The patient receives instructions on how to properly insert and remove the lenses, and they practice this under the provider's supervision to ensure proficiency. Additionally, the patient may be provided with sample lenses from various manufacturers to trial, allowing them to determine which lenses best suit their needs. Throughout this trial period, incidental revisions to the lenses' optical and physical characteristics may occur to further improve visual acuity or comfort. All of these services are conducted by the medical provider, ensuring a thorough and personalized approach to contact lens fitting.

1. Indications

The procedure associated with CPT® Code 92313 is indicated for patients requiring specialized contact lenses to address specific vision needs. The following conditions may warrant the fitting of corneoscleral lenses:

Corneal irregularities - Patients with irregular corneal shapes that cannot be adequately corrected with standard soft contact lenses.
Severe dry eye syndrome - Individuals suffering from significant dryness that necessitates a lens providing a larger surface area for moisture retention.
Post-surgical conditions - Patients who have undergone corneal surgeries, such as keratoplasty, may benefit from corneoscleral lenses for improved vision and comfort.
Aphakia - Patients who have had cataract surgery and require correction for the absence of the natural lens.

2. Procedure

The procedure for the fitting of corneoscleral lenses involves several key steps to ensure the lenses meet the patient's visual and comfort needs. The following outlines the procedural steps:

Step 1: Patient Assessment - The medical provider begins with a thorough assessment of the patient's vision needs, including a review of their medical history and current vision problems. This assessment helps in determining the most suitable type of contact lens.
Step 2: Lens Selection - Based on the assessment, the provider discusses various contact lens options with the patient, explaining the pros and cons of each type. The provider specifies the optical and physical characteristics of the lenses, such as power, size, curvature, flexibility, and gas-permeability.
Step 3: Lens Fitting - The provider inserts the selected corneoscleral lenses onto the patient's eyes. The fit of the lenses is carefully checked to ensure they provide optimal visual acuity and comfort. Adjustments are made as necessary to achieve the best fit.
Step 4: Patient Instruction - The patient is instructed on the proper techniques for inserting and removing the lenses. They practice these techniques under the supervision of the provider to ensure they are comfortable and capable of managing their lenses independently.
Step 5: Trial Period - The patient may be given sample lenses from different manufacturers to try for a specified period. During this trial, the provider may make incidental revisions to the lenses' optical and physical characteristics to enhance visual acuity or comfort based on the patient's feedback.

3. Post-Procedure

After the fitting of corneoscleral lenses, the patient is expected to follow specific post-procedure care instructions provided by the medical provider. This may include guidelines on lens hygiene, wearing schedules, and follow-up appointments to monitor the fit and comfort of the lenses. The provider may schedule follow-up visits to assess the patient's adaptation to the lenses and make any necessary adjustments. It is important for the patient to report any discomfort, vision changes, or complications during the trial period to ensure timely intervention and optimal lens performance.

Short Descr	C-LENS FITG CORNEOSCLRL LENS
Medium Descr	RX&FITG CONTACT LENS CORNEOSCLERAL LENS
Long Descr	Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneoscleral lens
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

RT	Right side (used to identify procedures performed on the right side of the body)
22	Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
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).
76	Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
AQ	Physician providing a service in an unlisted health professional shortage area (hpsa)
CC	Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR	Catastrophe/disaster related
GA	Waiver of liability statement issued as required by payer policy, individual case
GC	This service has been performed in part by a resident under the direction of a teaching physician
GX	Notice of liability issued, voluntary under payer policy
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
KX	Requirements specified in the medical policy have been met
LT	Left side (used to identify procedures performed on the left side of the body)
SC	Medically necessary service or supply