DRY EYE PATIENTS MAY BENEFIT FROM CONTACT LENS THERAPY

CONTACT LENSES are utilized mostly for refractive and vision concerns, but the therapeutic benefits can prove valuable in relieving pain and promoting healing, especially in regard to dry eye disease (DED). This is because DED can result in the corneal epithelium becoming compromised, which can hinder ocular surface healing.

Bandage contact lenses, scleral contact lenses and amniotic membrane contact lenses are available to treat DED, depending on the severity of the condition.

1 ACUTE DED

For acute, more mild to moderate cases of DED in which the patient’s symptoms and healing cannot be controlled with pharmaceutical treatment, bandage contact lenses may be utilized to make the patient more comfortable. Specifically, the lens acts as a shield from the mechanical irritation from the eyelid, allowing the corneal surface to heal.

Billing note. The proper CPT code is 92071: “fitting of a contact lens for the treatment of ocular surface disease.” The contact lens material may be billed as well, with a 99070 supply code, but most eye care providers typically use a (diagnostic) disposable contact lens, in which case it would be inappropriate to bill for that. Additionally, Medicare identifies 99070 as always bundled with the associated code, so there is no separate payment for the bandage contact lens.

2 CHRONIC DED

For more chronic, severe cases, scleral contact lenses can be utilized. This option provides a “tear reservoir” inside the bowl of the scleral lens while worn, essentially bathing the ocular surface. These lenses also provide a shield to the damaged cornea. This option is useful for the eye care provider who suspects the need for long-term treatment.

Billing. The proper CPT code is also 92071, as the provider is communicating with the payer that this treatment (contact lens) is being utilized for the treatment of ocular surface disease and not specifically for refractive purposes. The contact lens material will need to be billed in this case. The proper code for a scleral lens is V2531 (GP scleral lens) and is billed individually for each lens.

3 SEVERE DED

For the more severe cases of ocular surface keratitis, amniotic membranes may be necessary. Amniotic membranes are biological corneal bandages, an FDA class II medical device, that reduce inflammation and promote healing.

Billing. The proper CPT code for an amniotic membrane is 65778. This is considered a surgical code payment for the, “placement of amniotic membrane on the ocular surface for wound-healing; self-retaining.” No additional codes are needed, as reimbursement for the amniotic membrane is included. Additionally, the office visit is included. OM

DR. MILLER is a partner/owner at Eyecare Professionals of Powell, in Powell, Ohio. He is past president of the Ohio Optometric Association and is an Assistant Professor of Clinical Practice at The Ohio State University College of Optometry. Dr. Miller has received honoraria for consulting, lecturing, acting in an advisory capacity or research from: Alcon Laboratories, Allergan, Bausch+ Lomb, J&J Vision Care, RevolutionEHR and Shire.