Keratoconus – Doctor Education Resources

KERATOCONUS

DOCTOR EDUCATION
RESOURCES

EDUCATIONAL EXAMPLES

TOPOGRAPHY | PACHYMETRY

Samples of Topography and Pachymetry data results.

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GRADING CLASSIFICATION

CORNEAL STEEPENING BY CURVATURE

Corneal topography is recommended to measure the absolute steepest part of the cornea at the height of the cone (More Accurate).  If a corneal topographer is not available, use a manual or auto-keratometer (Not as precise).

MILD KERATOCONUS

Steepest corneal curvature of ≤ 48.00D

MODERATE KERATOCONUS

Steepest corneal curvature of 48.00D to 53.00D

ADVANCED KERATOCONUS

Steepest corneal curvature of ≥ 53.00D

CORNEAL THICKNESS BY MICRONS

The average corneal thickness is “approximately” 555 μm.  An Ultrasound pachymeter is helpful but an Optical Coherence Tomographer pachymetry would give more precision.

MILD KERATOCONUS

Lowest corneal thickness of ≥ 500μm

MODERATE KERATOCONUS

Lowest corneal thickness of 300μm – 500μm

ADVANCED KERATOCONUS

Lowest corneal thickness of ≤ 300μm

ICD-10 CODES

ICD-10 CODES FOR KERATOCONUS

List of Keratoconus ICD-10 reference codes.

  • H18.6 Keratoconus
  • H18.60 Keratoconus, unspecified
  • H18.601 Right Eye
  • H18.602 Left Eye
  • H18.603 Bilateral
  • H18.609 Unspecified Eye
  • H18.61 Keratoconus, Stable
  • H18.611 Right Eye
  • H18.612 Left Eye
  • H18.613 Bilateral
  • H18.619 Unspecified Eye
  • H18.62 Keratoconus, Unstable
  • H18.621 Right Eye
  • H18.622 Left Eye
  • H18.623 Bilateral
  • H18.629 Unspecified Eye

USEFUL CPT CODES

BILLING CODES

Disclaimer:  Please note that we are not billing experts so please use caution.  These codes are not meant to help and must be verified.

CONTACT LENS FITTING
  • 92310 Contact lens fitting for corneal lenses, both eyes, except for aphakia.
    This is a bilateral code for fitting soft contact lenses or corneal GP lenses, unless the patient has aphakia.
  • 92311 Contact lens fitting of a corneal lens for aphakia, one eye.
    For fitting a soft contact lens or corneal GP lens for aphakia.
  • 92312 Contact lens fitting of a corneal lens for aphakia, both eyes.
    Fitting code for soft contact lens or corneal GP lens for a patient who has aphakia if you are fitting both eyes.
  • 92313 Contact lens fitting of a corneoscleral lens, both eyes.
    Fitting code for patients with a corneoscleral lens, mini-scleral lens, or full scleral lens.
  • 92071 Fitting of a contact lens for treatment of ocular surface disease.
    Typically used when bandage contact lens is used to treat patient with dry eyes(with punctuate keratitis). This code is for the contact lens fitting portion. Supply of lens material should be billed separately.
  • 92072 Fitting of a contact lens for management of keratoconus, initial fitting.
    Code for fitting a patient’s with keratoconus with soft lens, corneal GP, hybrid, scleral.
  • 92499 Other ophthalmological services or procedures.
    Code for fitting a custom impression-based scleral lens.
CONTACT LENS MATERIAL
  • V2510 Contact Lens, GP, Spherical, Per Lens.
    Example: Spherical gas permeable lens.
  • V2511 Contact Lens, GP, Toric, Per Lens.
    Example: Toric gas permeable lens.
  • V2512 Contact Lens, GP, Bifocal, Per Lens.
    Example: Translating multifocal GP lens or an aspheric multifocal GP lens.
  • V2513 Contact Lens, GP, Extended Wear, Per Lens.
    Example: Hyper-Dk lens material or for patients who are sleeping in their lenses.
  • V2520 Contact Lens, Hydrophilic, Spherical, Per Lens .
    Example: Spherical soft contact lens.
  • V2521 Contact Lens, Hydrophilic, Toric, Per Lens.
    Example: Toric soft contact lens.
  • V2522 Contact Lens, Hydrophilic, Bifocal, Per Lens.
    Example: Standard soft multifocal lens.
  • V2523 Contact Lens, Hydrophilic, Extended Wear, Per Lens.
    Example: High-Dk contact lens material or when your patients are sleeping in their contact lenses.
  • V2531 Contact Lens, GP, Scleral, Per Lens.
    Example: When fitting scleral lenses (including corneo-scleral, mini-scleral, or full scleral). Do not use V2530, which is a scleral lens that is gas-impermeable. All scleral lenses are made of GP materials to keep the eye healthy.
  • V2599 Other Type of Contact Lens and Miscellaneous.
    Example: Other types of contact lenses, such as hybrid lenses. It can also be used for an impression-based scleral lens. Also, Miscellaneous and not described.
  • V2627 Scleral Cover Shell.
    Note: While similar, each insurance company has its own specifications when it comes to submitting claims. So please check with your insurance provider for guidance.
OTHER CODES
  • 92285 Anterior Segment Photos.
    Example: Anterior segment photos for corneal scarring or hydrops secondary to Keratoconus or other corneal conditions.
  • 92XXX Ophthalmologic Eye Exam.
    Example: Level Dependent – New versus Existing.
  • 92015 Refraction.
    Example: To determine refractive state and best correct visual acuity.
  • 92025 Corneal Topography.
    Example: Mapping of the corneal surface to determine curvature and irregularity.
  • 92132 Anterior segment OCT imaging.
    Example: Using an Optical Coherence Tomographer to determine corneal thickness.
  • 76514 Pachymetry.
    Example: Using ultrasound to determine corneal thickness.

HELPFUL TIPS

DIAGNOSIS OF KERATOCONUS

Steep Corneas:  Central K > 48.0 D

Thin central cornea :  Pachymetry  < 470 um

Inferior and Superior K Topographical Difference > 1.4 D

Asymmetry Between the Right and Left Eye Curvature ( > 1.9 D difference central Ks)

Large Difference Between Thinnest and Central Points ( >30 um)

Difference of > 23 um in Central Corneal Thickness between 2 eyes

Irregularity >1.5 D and > 2.0 D at 3.0 and 5.0 mm zones

Posterior elevation >0.050mm Note: Earliest Ectatic changes can only be seen in the posterior cornea

Posterior cornea and elevation maps:  Posterior elevation > +10 is suspicious

CLINICAL SIGNS

BCVA uncorrectable to 20/20

Oblique astigmatism

Scissoring reflex on retinoscopy

Oil droplet reflex on Direct Ophthalmoscopy

Munson sign (Inferior Gaze)

Rizutti sign –conical reflection with angled light source on cornea

Vogt’s Striae – Stromal striae

Fleisher Ring – Epithelial iron deposits – Best viewed with Blue Cobalt Light

Central or Inferior Corneal Thinning

Acute Hydrops (Later sign of Keratoconus)

Corneal Stromal Scarring (Resultant of hydrop and later sign of Keratoconus)

OTHER SIGNS

Difficult and variable subjective refractions

Autorefractor Readings and Subjective Refractions are vastly different

Patient often unhappy with glasses

More spectacle remakes

Rapidly increasing astigmatism and/or oblique astigmatism

Increased steeping on Keratometry readings from previous visit

Frequent rubbing of eyes

Complaints of Glare and Haloes and Difficulty with Night Driving

Vision was good until sudden worsening in High School – College years

Quickly changing from spherical contacts to toric contacts for astigmatism

Poorly fitting soft contacts