How To Use CPT Code 92313

CPT 92313 refers to the prescription and fitting of corneoscleral contact lenses, which are specialized lenses that cover both the cornea and the sclera of the eye. This procedure is essential for patients who require specific optical and physical characteristics in their lenses to improve vision and ensure proper fit. The process involves medical supervision to help the patient adapt to the new lenses, ensuring that they receive the necessary training and adjustments during the fitting process.

1. What is CPT code 92313?

CPT code 92313 represents the prescription of optical and physical characteristics of corneoscleral contact lenses, along with the fitting of these lenses under medical supervision. This code is specifically used when a healthcare provider prescribes lenses that are designed to enhance the patient’s vision while also considering the unique shape and size of their eyes. Corneoscleral lenses are particularly beneficial for patients with irregular corneas or other ocular conditions that require specialized lens designs. The fitting process is crucial, as it ensures that the lenses are comfortable and effective for the patient, and it is performed by a qualified medical provider rather than a technician.

2. Qualifying Circumstances

This CPT code can be used in specific circumstances where a patient requires corneoscleral lenses due to medical necessity. The criteria for using this code include situations where the lenses are needed for functional vision, such as after cataract surgery or for conditions like keratoconus. However, it is important to note that this code is not appropriate for prescriptions aimed at correcting normal vision abnormalities, such as nearsightedness or farsightedness. Additionally, some insurance plans may have restrictions, such as requiring a minimum level of vision impairment before covering the cost of contact lenses. If the fitting is performed by an independent technician, different codes must be used.

3. When To Use CPT 92313

CPT code 92313 is used when a healthcare provider prescribes and fits corneoscleral lenses for a patient, ensuring that the lenses meet the necessary optical and physical specifications. This code should be used when the provider is directly involved in the fitting process and provides medical supervision during the adaptation phase. It is important to avoid using this code in conjunction with codes that pertain to fittings performed by independent technicians, as those situations require different coding. For example, if the fitting is done by a technician, the appropriate code would be 92317 instead.

4. Official Description of CPT 92313

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

5. Clinical Application

CPT 92313 is applied in clinical settings where patients require specialized contact lenses to address specific vision problems. The importance of this service lies in its ability to provide patients with improved vision and comfort through the use of corneoscleral lenses. These lenses are particularly useful for individuals with unique ocular conditions that cannot be adequately addressed with standard contact lenses. The provider’s role in supervising the adaptation process is critical, as it ensures that any necessary adjustments can be made to optimize the fit and function of the lenses.

5.1 Provider Responsibilities

The provider’s responsibilities during the procedure include assessing the patient’s ocular health, determining the appropriate optical and physical characteristics of the corneoscleral lenses, and prescribing the lenses accordingly. The provider must also conduct the fitting process, which involves training the patient on how to properly insert, remove, and care for the lenses. Throughout this process, the provider monitors the patient’s adaptation to the lenses, making any necessary adjustments to ensure comfort and effectiveness.

5.2 Unique Challenges

One of the unique challenges associated with the fitting of corneoscleral lenses is the need for precise measurements and adjustments to accommodate the individual anatomy of the patient’s eyes. This process can be complex, as even minor discrepancies in fit can lead to discomfort or vision issues. Additionally, the provider must be skilled in educating the patient about the proper use and care of the lenses, as well as addressing any concerns or complications that may arise during the adaptation period.

5.3 Pre-Procedure Preparations

Before the procedure, the provider must conduct a thorough evaluation of the patient’s ocular health, including assessments of the cornea and sclera. This may involve diagnostic tests to measure the curvature and dimensions of the eye, as well as evaluating any underlying conditions that may affect lens fitting. The provider must also discuss the patient’s vision needs and expectations to ensure that the prescribed lenses will meet their requirements.

5.4 Post-Procedure Considerations

After the fitting of corneoscleral lenses, the provider must monitor the patient for any signs of discomfort or complications. Follow-up appointments are essential to assess the patient’s adaptation to the lenses and to make any necessary adjustments. The provider should also provide ongoing education about lens care and maintenance, as well as schedule regular check-ups to ensure the continued effectiveness of the lenses.

6. Relevant Terminology

Cornea: The clear and transparent covering in front of the eye that helps focus light.
Corneoscleral lens: A type of contact lens that rests on both the cornea and the sclera, providing a larger surface area for vision correction.
Gas permeability: The ability of a contact lens to allow oxygen to pass through, which is essential for maintaining eye health.
Optical characteristics: The specific properties of corrective lenses that enhance the wearer’s vision.
Sclera: The tough, fibrous outer layer of the eye, commonly referred to as the “white” of the eye.

7. Clinical Examples

1. A patient with keratoconus is prescribed corneoscleral lenses to improve their vision and comfort.
2. Following cataract surgery, a patient requires specialized lenses to restore functional vision.
3. An individual with irregular astigmatism is fitted with corneoscleral lenses to enhance visual acuity.
4. A patient who has undergone corneal transplant surgery is prescribed lenses to aid in their recovery and vision correction.
5. A child with a history of ocular trauma is fitted with corneoscleral lenses to manage their unique vision needs.
6. An adult with severe dry eye syndrome is prescribed corneoscleral lenses to provide moisture and comfort.
7. A patient with a history of failed standard contact lens fittings is evaluated for corneoscleral lenses.
8. A patient with high refractive error is fitted with corneoscleral lenses to achieve better visual outcomes.
9. An individual with a history of ocular surface disease is prescribed corneoscleral lenses for improved comfort.
10. A patient with aphakia is fitted with corneoscleral lenses to restore their vision post-surgery.