|
|
| Contractor Name |
| National Government Services, Inc. |
| Contractor Number |
| Number | Type | State(s) |
| 00130 |
FI |
IN |
| 00131 |
FI |
IL |
| 00160 |
FI |
KY |
| 00332 |
FI |
OH |
| 00450 |
FI |
WI |
| 00452 |
FI |
MI |
| 00453 |
FI |
VA, WV |
| 00630 |
Carrier |
IN |
| 00660 |
Carrier |
KY |
| 13101 |
MAC |
CT – Part A |
| 13102 |
MAC |
CT – Part B |
| 13201 |
MAC |
NY – Part A |
| 13202 |
MAC |
NY – Part B |
| 13282 |
MAC |
NY – Part B |
| 13292 |
MAC |
NY – Part B |
| Contractor Type |
| Carrier |
| Fiscal Intermediary |
| MAC – Part A |
| MAC- Part B |
LCD Information |
|
|
| LCD ID Number |
| L25466 |
| |
| LCD Title |
| Ophthalmology: Posterior Segment Imaging
(Extended Ophthalmoscopy and Fundus Photography) |
| |
| Contractor's Determination
Number |
| L25466 (R6) |
| |
| AMA CPT / ADA CDT Copyright
Statement |
| CPT codes, descriptions and other data
only are copyright 2010 American Medical Association (or such other
date of publication of CPT). All Rights Reserved. Applicable
FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT)
(including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association.
© 2002, 2004 American Dental Association. All rights reserved.
Applicable FARS/DFARS apply. |
| |
| CMS National Coverage
Policy |
Language quoted from Centers for Medicare
and Medicaid Services (CMS), National Coverage Determinations (NCDs)
and coverage provisions in interpretive manuals is italicized
throughout the policy. NCDs and coverage provisions in interpretive
manuals are not subject to the Local Coverage Determination (LCD)
Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In
addition, an administrative law judge may not review an NCD. See
§1869(f)(1)(A)(i) of the Social Security Act.
Unless
otherwise specified, italicized text represents quotation
from one or more of the following CMS sources:
Title XVIII
of the Social Security Act (SSA):
Section 1862(a)(1)(A)
excludes expenses incurred for items or services which are not
reasonable and necessary for the diagnosis or treatment of illness
or injury or to improve the functioning of a malformed body
member.
Section 1833(e) prohibits Medicare payment for any
claim which lacks the necessary information to process the claim.
Section 1862(a) (7) excludes routine physical examination
unless otherwise covered by statute.
Code of Federal
Regulations:
42 CFR Section 410.32 indicates that
diagnostic tests may only be ordered by the treating physician (or
other treating practitioner acting within the scope of his or her
license and Medicare requirements) who furnishes a
consultation or treats a beneficiary for a specific medical problem
and who uses the results in the management of the beneficiary's
specific medical problem. Tests not ordered by the physician (or
other qualified non-physician provider) who is treating the
beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1)
of this chapter).
CMS Publications:
CMS
Publication 100-04, Medicare Claims Manual, chapter 12:
40.1.A. Global surgery period |
| |
| Primary Geographic Jurisdiction |
| Number | Type | State(s) |
| 00130 |
FI |
IN |
| 00131 |
FI |
IL |
| 00160 |
FI |
KY |
| 00332 |
FI |
OH |
| 00450 |
FI |
WI |
| 00452 |
FI |
MI |
| 00453 |
FI |
VA, WV |
| 00630 |
Carrier |
IN |
| 00660 |
Carrier |
KY |
| 13101 |
MAC |
CT – Part A |
| 13102 |
MAC |
CT – Part B |
| 13201 |
MAC |
NY – Part A |
| 13202 |
MAC |
NY – Part B |
| 13282 |
MAC |
NY – Part B |
| 13292 |
MAC |
NY – Part B |
| |
| Oversight Region |
| Region I, II, III, V |
| |
| |
| Original Determination
Effective Date |
| For services performed on or after
12/01/2007 |
| |
| Original Determination
Ending Date |
| |
| |
| Revision Effective
Date |
| For services performed on or after
01/01/2011 |
| |
| Revision Ending
Date |
| |
| |
| Indications and Limitations
of Coverage and/or Medical Necessity |
Abstract:
Fundus
photography
Fundus photography involves the use of a retinal
camera to document abnormalities of of the retina and disease
processes affecting the eye, in order to follow the progress of such
disease. The test must be used in the medical decision making for
the patient.
Extended ophthalmoscopy
Extended
ophthalmoscopy is the detailed examination of the retina and always
includes a true drawing of the retina, with interpretation and
report. It is most frequently performed utilizing an indirect
lens, although it may be performed using contact lens biomicroscopy.
It may require scleral depression and is usually performed with the
pupil dilated. It is performed by the physician when a more detailed
examination (including that of the periphery) is needed, following
routine ophthalmoscopy. The examination must be used in the medical
decision making for the
patient.
Indications:
Fundus
photography
Fundus photography may be indicated to document
abnormalities of disease processes affecting the eye, or to follow
the progress of such disease.
In order to document a disease
process or follow the progress of a disease, photographs and an
interpretation and report of the test may be necessary. Photographs
and an interpretation and report of the test may also be necessary
to plan treatment for a disease process.
Fundus photography
may be used for the diagnosis of conditions such as macular
degeneration, retinal neoplasms, choroid disturbances and diabetic
retinopathy, glaucoma, multiple sclerosis or other central nervous
system anomalies.
Fundus photography may be indicated for
examination of the retina in diabetic patients, in whom symptoms of
visual disturbances may be present and in whom retinal examination
may be unremarkable or normal.
Extended
ophthalmoscopy
Extended ophthalmoscopy is indicated when the
level of examination requires a complete view of the posterior
segment of the eye and documentation is greater than that required
for general ophthalmoscopy.
An extended ophthalmoscopy may be
considered medically reasonable and necessary for the following
conditions:
- Malignant neoplasm of the retina or choroid.
- Retained (old) intraocular foreign body, either magnetic or
nonmagnetic. Signs and symptoms may include a statement by the
patient that something has hit his/her eye (foreign body
sensation), normal or blurred vision, pain or no discomfort, and
tearing.
- Retinal hemorrhage, edema, ischemia, exudates and deposits,
hereditary retinal dystrophies or peripheral retinal
degeneration.
- Retinal detachment with or without retinal defect. The patient
may complain of light flashes, dark floating specks, and blurred
vision that becomes progressively worse. This may be described by
the patient as "a curtain came down over my eyes."
- Symptoms suggestive of retinal defect (ex: flashes and/or
floaters).
- Retinal defects without retinal detachment.
- Diabetic retinopathy (i.e., background retinopathy or
proliferative retinopathy), retinal vascular occlusion, or
separation of the retinal layers. This may be evidenced by
microaneurysms, cotton wool spots, exudates, hemorrhages, or
fibrous proliferation.
- Experienced sudden visual loss or transient visual
loss.
- Chorioretinitis, chorioretinal scars or choroidal
degeneration, dystrophies, hemorrhage and rupture, or
detachment.
- Sustained a penetrating wound to the orbit resulting in the
retention of a foreign body in the eye.
- Sustained a blunt injury to the eye or pariorbita.
- Disorders of the vitreous body (i.e., vitreous hemorrhage or
posterior vitreous detachment). Spots before the eyes (floaters)
and flashing lights (photopsia) can be signs/symptoms of these
disorders.
- Posterior scleritis. Signs and symptoms may include severe
pain and inflammation, proptosis, limited ocular movements, and a
loss of a portion of the visual field.
- Vogt-Koyanagi syndrome. A condition characterized by bilateral
uveitis, dysacousia, meningeal irritation, whitening of patches of
hair (poliosis), vitiligo, and retinal detachment. The disease can
be initiated by a severe headache, deep orbital pain, vertigo, and
nausea.
- Degenerative disorders of the globe.
- Retinoschisis and retinal cysts. Patients may complain of
light flashes and floaters.
- Signs and symptoms of endophthalmitis, which may include
severe pain, redness, photophobia, and profound loss of vision.
- Glaucoma or is a glaucoma suspect. This may be evidenced by
increased intraocular pressure or progressive cupping of the optic
nerve.
- Systemic disorders which may be associated with retinal
pathology.
- High axial length myopia
- Retinal edema
- Metamorphopsia
- High-risk medication for retinopathy or optic
neuropathy.
- Choroidal nevus being evaluated for malignant
transformation.
- Macular degeneration.
Limitations:
If the
study is performed as a screening service, it is not covered by
Medicare.
Fundus photography
- All tests must include a written interpretation. If an
interpretation is not included in the same medical record with the
photograph, then both the technical and professional components
will be considered not medically necessary.
- Fundus photography (CPT codes 92250 and
92228) are bilateral services on the Medicare Physician Fee
Schedule Data Base. Services performed unilaterally are subject to
a reduction in fee.
- Fundus photography is not a substitute for an annual dilated
examination by a qualified professional (e.g., in diabetic
patients). Fundus photographs taken by a non-eye professional and
sent (transtelephonically, via internet, or by other means) to a
qualified professional for interpretation are
covered for the monitoring and management of active retinal
disease. The interpretation of tests done with remote imaging must
be performed by a physician or qualified non-physician
practitioner.
- Remote imaging for detection of retinal
disease (CPT code 92227) is considered screening and will be
denied as non-covered.
- Provision of fundus photography, by providers other than
opthalmologists or optometrists, as a screening test to facilitate
referral to a specialist is contrary to requirements for testing
as codified in 42CFR 410.32, and is therefore not covered.
Furthermore, the ordering/performance of fundus photography by eye
specialists prior to a face-to-face encounter is similarly not
covered or reimbursable.
Extended ophthalmoscopy
- Extended ophthalmoscopy of a fellow eye without signs or
symptoms or new abnormalities on general ophthalmoscopic exam will
be denied as not medically necessary. Repeated extended
ophthalmoscopy at each visit without change in signs, symptoms or
condition may be denied as not medically necessary.
- General ophthalmoscopy and biomicroscopy are part of an
ophthalmologic examination (92002-92004) and are not separately
payable, but these should still be documented in the patient's
medical record.
- If indirect ophthalmoscopy is done without a drawing or does
not meet the standards indicated in the attached Appendix A, the
service is not separately payable and will be considered part of a
general ophthalmologic exam (92002-92014) or E&M service.
- Extended ophthalmoscopy (codes 92225, 92226) performed during
the global surgery period of an ophthalmologic surgery procedure,
by the same provider performing the surgery, will not be
separately payable unless unrelated to the condition for which the
surgery was performed.
- If the medical record does not include the interpretation and
report, the extended ophthalmoscopy will be denied as not
medically necessary.
- Extended ophthalmoscopy will be denied as not medically
necessary when it is done in lieu of routine ophthalmoscopy unless
the indication for this more extensive examination is documented
in the medical record.
- When other ophthalmological tests (e.g., fundus photography,
fluorescein angiography, ultrasound, optical coherence tomography,
etc.) have been performed, extended ophthalmoscopy will be denied
as not medically necessary unless there was a reasonable medical
expectation that the multiple imaging services might provide
additive (non-duplicative) information.
Other
Comments:
For claims submitted to the fiscal intermediary
or Part A MAC: this coverage determination also applies within
states outside the primary geographic jurisdiction with facilities
that have nominated National Government Services to process their
claims.
Bill type codes only apply to providers who bill
these services to the fiscal intermediary or Part A MAC. Bill type
codes do not apply to physicians, other professionals and suppliers
who bill these services to the carrier or Part B
MAC.
Limitation of liability and refund requirements apply
when denials are likely, whether based on medical necessity or other
coverage reasons. The provider/supplier must notify the beneficiary
in writing, prior to rendering the service, if the provider/supplier
is aware that the test, item or procedure may not be covered by
Medicare. The limitation of liability and refund requirements do not
apply when the test, item or procedure is statutorily excluded, has
no Medicare benefit category or is rendered for screening
purposes.
For dates of service prior to April 1, 2010, FQHC
services should be reported with bill type 73X. For dates of service
on or after April 1, 2010, bill type 77X should be used to report
FQHC services. |
| | |
Coding Information |
|
|
| Bill Type
Codes:
Contractors may specify Bill Types to help providers identify
those Bill Types typically used to report this service. Absence of a
Bill Type does not guarantee that the policy does not apply to that
Bill Type. Complete absence of all Bill Types indicates that
coverage is not influenced by Bill Type and the policy should be
assumed to apply equally to all claims. |
| 012x |
Hospital Inpatient (Medicare Part B only) |
| 013x |
Hospital Outpatient |
| 021x |
Skilled Nursing - Inpatient (Including Medicare
Part A) |
| 071x |
Clinic - Rural Health |
| 073x |
Clinic - Freestanding |
| 077x |
Clinic - Federally Qualified Health Center
(FQHC) |
| 085x |
Critical Access
Hospital | |
| |
| Revenue Codes:
Contractors may specify Revenue Codes to help providers identify
those Revenue Codes typically used to report this service. In most
instances Revenue Codes are purely advisory; unless specified in the
policy services reported under other Revenue Codes are equally
subject to this coverage determination. Complete absence of all
Revenue Codes indicates that coverage is not influenced by Revenue
Code and the policy should be assumed to apply equally to all
Revenue Codes. |
Revenue codes only
apply to providers who bill these services to the fiscal
intermediary or Part A MAC. Revenue codes do not apply to
physicians, other professionals and suppliers who bill these
services to the carrier or Part B MAC.
Please note that not
all revenue codes apply to every type of bill code. Providers are
encouraged to refer to the FISS revenue code file for allowable bill
types. Similarly, not all revenue codes apply to each CPT/HCPCS
code. Providers are encouraged to refer to the FISS HCPCS file for
allowable revenue codes.
| 0409 |
Other Imaging Services - Other Imaging
Services |
| 0450 |
Emergency Room - General Classification |
| 051X |
Clinic - General Classification |
| 052X |
Free-Standing Clinic - General
Classification |
| 0962 |
Professional Fees -
Ophthalmology | |
| |
| CPT/HCPCS
Codes |
| 92225 |
OPHTHALMOSCOPY, EXTENDED, WITH RETINAL
DRAWING (EG, FOR RETINAL DETACHMENT, MELANOMA), WITH
INTERPRETATION AND REPORT; INITIAL |
| 92226 |
OPHTHALMOSCOPY, EXTENDED, WITH RETINAL
DRAWING (EG, FOR RETINAL DETACHMENT, MELANOMA), WITH
INTERPRETATION AND REPORT; SUBSEQUENT |
| 92227 |
REMOTE IMAGING FOR DETECTION OF RETINAL
DISEASE (EG, RETINOPATHY IN A PATIENT WITH DIABETES)
WITH ANALYSIS AND REPORT UNDER PHYSICIAN SUPERVISION,
UNILATERAL OR BILATERAL |
| 92228 |
REMOTE IMAGING FOR MONITORING AND
MANAGEMENT OF ACTIVE RETINAL DISEASE (EG, DIABETIC
RETINOPATHY) WITH PHYSICIAN REVIEW, INTERPRETATION AND
REPORT, UNILATERAL OR BILATERAL |
| 92250 |
FUNDUS PHOTOGRAPHY WITH INTERPRETATION
AND
REPORT | | |
| |
| ICD-9 Codes that Support
Medical Necessity |
ICD-9-CM codes for fundus photography
and extended ophthalmoscopy (CPT codes 92225,
92226, 92228, 92250)
| 115.02 |
HISTOPLASMA CAPSULATUM RETINITIS |
| 115.12 |
HISTOPLASMA DUBOISII RETINITIS |
| 115.92 |
HISTOPLASMOSIS RETINITIS
UNSPECIFIED |
| 130.2 |
CHORIORETINITIS DUE TO
TOXOPLASMOSIS |
| 190.0 |
MALIGNANT NEOPLASM OF EYEBALL EXCEPT
CONJUNCTIVA CORNEA RETINA AND CHOROID |
| 190.5 |
MALIGNANT NEOPLASM OF RETINA |
| 190.6 |
MALIGNANT NEOPLASM OF CHOROID |
| 224.5 |
BENIGN NEOPLASM OF RETINA |
| 224.6 |
BENIGN NEOPLASM OF CHOROID |
| 225.1 |
BENIGN NEOPLASM OF CRANIAL NERVES |
| 249.50 |
SECONDARY DIABETES MELLITUS WITH
OPHTHALMIC MANIFESTATIONS, NOT STATED AS UNCONTROLLED,
OR UNSPECIFIED |
| 249.51 |
SECONDARY DIABETES MELLITUS WITH
OPHTHALMIC MANIFESTATIONS, UNCONTROLLED |
| 250.50 |
DIABETES WITH OPHTHALMIC MANIFESTATIONS,
TYPE II OR UNSPECIFIED TYPE, NOT STATED AS
UNCONTROLLED |
| 250.51 |
DIABETES WITH OPHTHALMIC MANIFESTATIONS,
TYPE I [JUVENILE TYPE], NOT STATED AS UNCONTROLLED |
| 250.52 |
DIABETES WITH OPHTHALMIC MANIFESTATIONS,
TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED |
| 250.53 |
DIABETES WITH OPHTHALMIC MANIFESTATIONS,
TYPE I [JUVENILE TYPE], UNCONTROLLED |
| 360.00 |
PURULENT ENDOPHTHALMITIS
UNSPECIFIED |
| 360.01 |
ACUTE ENDOPHTHALMITIS |
| 360.02 |
PANOPHTHALMITIS |
| 360.03 |
CHRONIC ENDOPHTHALMITIS |
| 360.04 |
VITREOUS ABSCESS |
| 360.11 |
SYMPATHETIC UVEITIS |
| 360.12 |
PANUVEITIS |
| 360.13 |
PARASITIC ENDOPHTHALMITIS
UNSPECIFIED |
| 360.14 |
OPHTHALMIA NODOSA |
| 360.19 |
OTHER ENDOPHTHALMITIS |
| 360.20 |
DEGENERATIVE DISORDER OF GLOBE
UNSPECIFIED |
| 360.21 |
PROGRESSIVE HIGH (DEGENERATIVE)
MYOPIA |
| 360.23 |
SIDEROSIS OF GLOBE |
| 360.24 |
OTHER METALLOSIS OF GLOBE |
| 360.29 |
OTHER DEGENERATIVE DISORDERS OF
GLOBE |
| 360.30 |
HYPOTONY OF EYE UNSPECIFIED |
| 360.31 |
PRIMARY HYPOTONY OF EYE |
| 360.32 |
OCULAR FISTULA CAUSING HYPOTONY |
| 360.33 |
HYPOTONY ASSOCIATED WITH OTHER OCULAR
DISORDERS |
| 360.34 |
FLAT ANTERIOR CHAMBER OF EYE |
| 360.40 |
DEGENERATED GLOBE OR EYE
UNSPECIFIED |
| 360.41 |
BLIND HYPOTENSIVE EYE |
| 360.42 |
BLIND HYPERTENSIVE EYE |
| 360.43 |
HEMOPHTHALMOS EXCEPT CURRENT INJURY |
| 360.44 |
LEUCOCORIA |
| 360.50 |
FOREIGN BODY MAGNETIC INTRAOCULAR
UNSPECIFIED |
| 360.51 |
FOREIGN BODY MAGNETIC IN ANTERIOR CHAMBER
OF EYE |
| 360.52 |
FOREIGN BODY MAGNETIC IN IRIS OR CILIARY
BODY |
| 360.53 |
FOREIGN BODY MAGNETIC IN LENS |
| 360.54 |
FOREIGN BODY MAGNETIC IN VITREOUS |
| 360.55 |
FOREIGN BODY MAGNETIC IN POSTERIOR
WALL |
| 360.59 |
INTRAOCULAR FOREIGN BODY MAGNETIC IN
OTHER OR MULTIPLE SITES |
| 360.60 |
FOREIGN BODY INTRAOCULAR
UNSPECIFIED |
| 360.61 |
FOREIGN BODY IN ANTERIOR CHAMBER |
| 360.62 |
FOREIGN BODY IN IRIS OR CILIARY
BODY |
| 360.63 |
FOREIGN BODY IN LENS |
| 360.64 |
FOREIGN BODY IN VITREOUS |
| 360.65 |
FOREIGN BODY IN POSTERIOR WALL OF
EYE |
| 360.69 |
INTRAOCULAR FOREIGN BODY IN OTHER OR
MULTIPLE SITES |
| 360.81 |
LUXATION OF GLOBE |
| 360.89 |
OTHER DISORDERS OF GLOBE |
| 361.00 |
RETINAL DETACH WITH RETINAL DEFECT
UNSPECIFIED |
| 361.01 |
RECENT RETINAL DETACH PARTIAL WITH SINGLE
DEFECT |
| 361.02 |
RECENT RETINAL DETACH PARTIAL WITH
MULTIPLE DEFECTS |
| 361.03 |
RECENT RETINAL DETACH PARTIAL WITH GIANT
TEAR |
| 361.04 |
RECENT RETINAL DETACH PARTIAL WITH
RETINAL DIALYSIS |
| 361.05 |
RECENT RETINAL DETACH TOTAL OR
SUBTOTAL |
| 361.06 |
OLD RETINAL DETACH PARTIAL |
| 361.07 |
OLD RETINAL DETACH TOTAL OR
SUBTOTAL |
| 361.10 |
RETINOSCHISIS UNSPECIFIED |
| 361.11 |
FLAT RETINOSCHISIS |
| 361.12 |
BULLOUS RETINOSCHISIS |
| 361.13 |
PRIMARY RETINAL CYSTS |
| 361.14 |
SECONDARY RETINAL CYSTS |
| 361.19 |
OTHER RETINOSCHISIS AND RETINAL
CYSTS |
| 361.2 |
SEROUS RETINAL DETACH |
| 361.30 |
RETINAL DEFECT UNSPECIFIED |
| 361.31 |
ROUND HOLE OF RETINA WITHOUT DETACH |
| 361.32 |
HORSESHOE TEAR OF RETINA WITHOUT
DETACH |
| 361.33 |
MULTIPLE DEFECTS OF RETINA WITHOUT
DETACH |
| 361.81 |
TRACTION DETACH OF RETINA |
| 361.89 |
OTHER FORMS OF RETINAL DETACH |
| 361.9 |
UNSPECIFIED RETINAL DETACH |
| 362.01 |
BACKGROUND DIABETIC RETINOPATHY |
| 362.02 |
PROLIFERATIVE DIABETIC RETINOPATHY |
| 362.03 |
NONPROLIFERATIVE DIABETIC RETINOPATHY
NOS |
| 362.04 |
MILD NONPROLIFERATIVE DIABETIC
RETINOPATHY |
| 362.05 |
MODERATE NONPROLIFERATIVE DIABETIC
RETINOPATHY |
| 362.06 |
SEVERE NONPROLIFERATIVE DIABETIC
RETINOPATHY |
| 362.07 |
DIABETIC MACULAR EDEMA |
| 362.10 |
BACKGROUND RETINOPATHY UNSPECIFIED |
| 362.11 |
HYPERTENSIVE RETINOPATHY |
| 362.12 |
EXUDATIVE RETINOPATHY |
| 362.13 |
CHANGES IN VASCULAR APPEARANCE OF
RETINA |
| 362.14 |
RETINAL MICROANEURYSMS NOS |
| 362.15 |
RETINAL TELANGIECTASIA |
| 362.16 |
RETINAL NEOVASCULARIZATION NOS |
| 362.17 |
OTHER INTRARETINAL MICROVASCULAR
ABNORMALITIES |
| 362.18 |
RETINAL VASCULITIS |
| 362.20 |
RETINOPATHY OF PREMATURITY,
UNSPECIFIED |
| 362.21 |
RETROLENTAL FIBROPLASIA |
| 362.22 |
RETINOPATHY OF PREMATURITY, STAGE 0 |
| 362.23 |
RETINOPATHY OF PREMATURITY, STAGE 1 |
| 362.24 |
RETINOPATHY OF PREMATURITY, STAGE 2 |
| 362.25 |
RETINOPATHY OF PREMATURITY, STAGE 3 |
| 362.26 |
RETINOPATHY OF PREMATURITY, STAGE 4 |
| 362.27 |
RETINOPATHY OF PREMATURITY, STAGE 5 |
| 362.29 |
OTHER NONDIABETIC PROLIFERATIVE
RETINOPATHY |
| 362.30 |
RETINAL VASCULAR OCCLUSION
UNSPECIFIED |
| 362.31 |
CENTRAL RETINAL ARTERY OCCLUSION |
| 362.32 |
RETINAL ARTERIAL BRANCH OCCLUSION |
| 362.33 |
PARTIAL RETINAL ARTERIAL OCCLUSION |
| 362.34 |
TRANSIENT RETINAL ARTERIAL
OCCLUSION |
| 362.35 |
CENTRAL RETINAL VEIN OCCLUSION |
| 362.36 |
VENOUS TRIBUTARY (BRANCH) OCCLUSION OF
RETINA |
| 362.37 |
VENOUS ENGORGEMENT OF RETINA |
| 362.40 |
RETINAL LAYER SEPARATION
UNSPECIFIED |
| 362.41 |
CENTRAL SEROUS RETINOPATHY |
| 362.42 |
SEROUS DETACH OF RETINAL PIGMENT
EPITHELIUM |
| 362.43 |
HEMORRHAGIC DETACH OF RETINAL PIGMENT
EPITHELIUM |
| 362.50 |
MACULAR DEGENERATION (SENILE) OF RETINA
UNSPECIFIED |
| 362.51 |
NONEXUDATIVE SENILE MACULAR DEGENERATION
OF RETINA |
| 362.52 |
EXUDATIVE SENILE MACULAR DEGENERATION OF
RETINA |
| 362.53 |
CYSTOID MACULAR DEGENERATION OF
RETINA |
| 362.54 |
MACULAR CYST HOLE OR PSEUDOHOLE OF
RETINA |
| 362.55 |
TOXIC MACULOPATHY OF RETINA |
| 362.56 |
MACULAR PUCKERING OF RETINA |
| 362.57 |
DRUSEN (DEGENERATIVE) OF RETINA |
| 362.60 |
PERIPHERAL RETINAL DEGENERATION
UNSPECIFIED |
| 362.61 |
PAVING STONE DEGENERATION OF RETINA |
| 362.62 |
MICROCYSTOID DEGENERATION OF RETINA |
| 362.63 |
LATTICE DEGENERATION OF RETINA |
| 362.64 |
SENILE RETICULAR DEGENERATION OF
RETINA |
| 362.65 |
SECONDARY PIGMENTARY DEGENERATION OF
RETINA |
| 362.66 |
SECONDARY VITREORETINAL
DEGENERATIONS |
| 362.70 |
HEREDITARY RETINAL DYSTROPHY
UNSPECIFIED |
| 362.71 |
RETINAL DYSTROPHY IN SYSTEMIC OR
CEREBRORETINAL LIPIDOSES |
| 362.72 |
RETINAL DYSTROPHY IN OTHER SYSTEMIC
DISORDERS AND SYNDROMES |
| 362.73 |
VITREORETINAL DYSTROPHIES |
| 362.74 |
PIGMENTARY RETINAL DYSTROPHY |
| 362.75 |
OTHER DYSTROPHIES PRIMARILY INVOLVING THE
SENSORY RETINA |
| 362.76 |
DYSTROPHIES PRIMARILY INVOLVING THE
RETINAL PIGMENT EPITHELIUM |
| 362.77 |
RETINAL DYSTROPHIES PRIMARILY INVOLVING
BRUCH'S MEMBRANE |
| 362.81 |
RETINAL HEMORRHAGE |
| 362.82 |
RETINAL EXUDATES AND DEPOSITS |
| 362.83 |
RETINAL EDEMA |
| 362.84 |
RETINAL ISCHEMIA |
| 362.85 |
RETINAL NERVE FIBER BUNDLE DEFECTS |
| 362.89 |
OTHER RETINAL DISORDERS |
| 363.00 |
FOCAL CHORIORETINITIS UNSPECIFIED |
| 363.01 |
FOCAL CHOROIDITIS AND CHORIORETINITIS
JUXTAPAPILLARY |
| 363.03 |
FOCAL CHOROIDITIS AND CHORIORETINITIS OF
OTHER POSTERIOR POLE |
| 363.04 |
FOCAL CHOROIDITIS AND CHORIORETINITIS
PERIPHERAL |
| 363.05 |
FOCAL RETINITIS AND RETINOCHOROIDITIS
JUXTAPAPILLARY |
| 363.06 |
FOCAL RETINITIS AND RETINOCHOROIDITIS
MACULAR OR PARAMACULAR |
| 363.07 |
FOCAL RETINITIS AND RETINOCHOROIDITIS OF
OTHER POSTERIOR POLE |
| 363.08 |
FOCAL RETINITIS AND RETINOCHOROIDITIS
PERIPHERAL |
| 363.10 |
DISSEMINATED CHORIORETINITIS
UNSPECIFIED |
| 363.11 |
DISSEMINATED CHOROIDITIS AND
CHORIORETINITIS POSTERIOR POLE |
| 363.12 |
DISSEMINATED CHOROIDITIS AND
CHORIORETINITIS PERIPHERAL |
| 363.13 |
DISSEMINATED CHOROIDITIS AND
CHORIORETINITIS GENERALIZED |
| 363.14 |
DISSEMINATED RETINITIS AND
RETINOCHOROIDITIS METASTATIC |
| 363.15 |
DISSEMINATED RETINITIS AND
RETINOCHOROIDITIS PIGMENT EPITHELIOPATHY |
| 363.20 |
CHORIORETINITIS UNSPECIFIED |
| 363.21 |
PARS PLANITIS |
| 363.22 |
HARADA'S DISEASE |
| 363.30 |
CHORIORETINAL SCAR UNSPECIFIED |
| 363.31 |
SOLAR RETINOPATHY |
| 363.32 |
OTHER MACULAR SCARS OF RETINA |
| 363.33 |
OTHER SCARS OF POSTERIOR POLE OF
RETINA |
| 363.34 |
PERIPHERAL SCARS OF RETINA |
| 363.35 |
DISSEMINATED SCARS OF RETINA |
| 363.40 |
CHOROIDAL DEGENERATION UNSPECIFIED |
| 363.41 |
SENILE ATROPHY OF CHOROID |
| 363.42 |
DIFFUSE SECONDARY ATROPHY OF
CHOROID |
| 363.43 |
ANGIOID STREAKS OF CHOROID |
| 363.50 |
HEREDITARY CHOROIDAL DYSTROPHY OR ATROPHY
UNSPECIFIED |
| 363.51 |
CIRCUMPAPILLARY DYSTROPHY OF CHOROID
PARTIAL |
| 363.52 |
CIRCUMPAPILLARY DYSTROPHY OF CHOROID
TOTAL |
| 363.53 |
CENTRAL DYSTROPHY OF CHOROID
PARTIAL |
| 363.54 |
CENTRAL CHOROIDAL ATROPHY TOTAL |
| 363.55 |
CHOROIDEREMIA |
| 363.56 |
OTHER DIFFUSE OR GENERALIZED DYSTROPHY OF
CHOROID PARTIAL |
| 363.57 |
OTHER DIFFUSE OR GENERALIZED DYSTROPHY OF
CHOROID TOTAL |
| 363.61 |
CHOROIDAL HEMORRHAGE UNSPECIFIED |
| 363.62 |
EXPULSIVE CHOROIDAL HEMORRHAGE |
| 363.63 |
CHOROIDAL RUPTURE |
| 363.70 |
CHOROIDAL DETACH UNSPECIFIED |
| 363.71 |
SEROUS CHOROIDAL DETACH |
| 363.72 |
HEMORRHAGIC CHOROIDAL DETACH |
| 363.8 |
OTHER DISORDERS OF CHOROID |
| 363.9 |
UNSPECIFIED DISORDER OF CHOROID |
| 364.22 |
GLAUCOMATOCYCLITIC CRISES |
| 364.24 |
VOGT-KOYANAGI SYNDROME |
| 364.3 |
UNSPECIFIED IRIDOCYCLITIS |
| 364.82 |
PLATEAU IRIS SYNDROME |
| 365.00 |
PREGLAUCOMA UNSPECIFIED |
| 365.01 |
OPEN ANGLE WITH BORDERLINE GLAUCOMA
FINDINGS |
| 365.02 |
ANATOMICAL NARROW ANGLE BORDERLINE
GLAUCOMA |
| 365.03 |
STEROID RESPONDERS BORDERLINE
GLAUCOMA |
| 365.04 |
OCULAR HYPERTENSION |
| 365.10 |
OPEN-ANGLE GLAUCOMA UNSPECIFIED |
| 365.11 |
PRIMARY OPEN ANGLE GLAUCOMA |
| 365.12 |
LOW TENSION OPEN-ANGLE GLAUCOMA |
| 365.13 |
PIGMENTARY OPEN-ANGLE GLAUCOMA |
| 365.14 |
GLAUCOMA OF CHILDHOOD |
| 365.15 |
RESIDUAL STAGE OF OPEN ANGLE
GLAUCOMA |
| 365.20 |
PRIMARY ANGLE-CLOSURE GLAUCOMA
UNSPECIFIED |
| 365.21 |
INTERMITTENT ANGLE-CLOSURE GLAUCOMA |
| 365.22 |
ACUTE ANGLE-CLOSURE GLAUCOMA |
| 365.23 |
CHRONIC ANGLE-CLOSURE GLAUCOMA |
| 365.24 |
RESIDUAL STAGE OF ANGLE-CLOSURE
GLAUCOMA |
| 365.31 |
CORTICOSTEROID-INDUCED GLAUCOMA
GLAUCOMATOUS STAGE |
| 365.32 |
CORTICOSTEROID-INDUCED GLAUCOMA RESIDUAL
STAGE |
| 365.41 |
GLAUCOMA ASSOCIATED WITH CHAMBER ANGLE
ANOMALIES |
| 365.42 |
GLAUCOMA ASSOCIATED WITH ANOMALIES OF
IRIS |
| 365.43 |
GLAUCOMA ASSOCIATED WITH OTHER ANTERIOR
SEGMENT ANOMALIES |
| 365.44 |
GLAUCOMA ASSOCIATED WITH SYSTEMIC
SYNDROMES |
| 365.51 |
PHACOLYTIC GLAUCOMA |
| 365.52 |
PSEUDOEXFOLIATION GLAUCOMA |
| 365.59 |
GLAUCOMA ASSOCIATED WITH OTHER LENS
DISORDERS |
| 365.60 |
GLAUCOMA ASSOCIATED WITH UNSPECIFIED
OCULAR DISORDER |
| 365.61 |
GLAUCOMA ASSOCIATED WITH PUPILLARY
BLOCK |
| 365.62 |
GLAUCOMA ASSOCIATED WITH OCULAR
INFLAMMATIONS |
| 365.63 |
GLAUCOMA ASSOCIATED WITH VASCULAR
DISORDERS OF EYE |
| 365.64 |
GLAUCOMA ASSOCIATED WITH TUMORS OR
CYSTS |
| 365.65 |
GLAUCOMA ASSOCIATED WITH OCULAR
TRAUMA |
| 365.81 |
HYPERSECRETION GLAUCOMA |
| 365.82 |
GLAUCOMA WITH INCREASED EPISCLERAL VENOUS
PRESSURE |
| 365.83 |
AQUEOUS MISDIRECTION |
| 365.89 |
OTHER SPECIFIED GLAUCOMA |
| 365.9 |
UNSPECIFIED GLAUCOMA |
| 368.11 |
SUDDEN VISUAL LOSS |
| 368.12 |
TRANSIENT VISUAL LOSS |
| 368.13 |
VISUAL DISCOMFORT |
| 368.14 |
VISUAL DISTORTIONS OF SHAPE AND
SIZE |
| 368.15 |
OTHER VISUAL DISTORTIONS AND ENTOPTIC
PHENOMENA |
| 368.16 |
PSYCHOPHYSICAL VISUAL DISTURBANCES |
| 368.40 |
VISUAL FIELD DEFECT UNSPECIFIED |
| 368.41 |
SCOTOMA INVOLVING CENTRAL AREA |
| 368.42 |
SCOTOMA OF BLIND SPOT AREA |
| 368.43 |
SECTOR OR ARCUATE VISUAL FIELD
DEFECTS |
| 368.44 |
OTHER LOCALIZED VISUAL FIELD DEFECT |
| 368.45 |
GENERALIZED VISUAL FIELD CONTRACTION OR
CONSTRICTION |
| 368.8 |
OTHER SPECIFIED VISUAL DISTURBANCES |
| 368.9 |
UNSPECIFIED VISUAL DISTURBANCE |
| 377.00 |
PAPILLEDEMA UNSPECIFIED |
| 377.01 |
PAPILLEDEMA ASSOCIATED WITH INCREASED
INTRACRANIAL PRESSURE |
| 377.02 |
PAPILLEDEMA ASSOCIATED WITH DECREASED
OCULAR PRESSURE |
| 377.03 |
PAPILLEDEMA ASSOCIATED WITH RETINAL
DISORDER |
| 377.04 |
FOSTER-KENNEDY SYNDROME |
| 377.10 |
OPTIC ATROPHY UNSPECIFIED |
| 377.11 |
PRIMARY OPTIC ATROPHY |
| 377.12 |
POSTINFLAMMATORY OPTIC ATROPHY |
| 377.13 |
OPTIC ATROPHY ASSOCIATED WITH RETINAL
DYSTROPHIES |
| 377.14 |
GLAUCOMATOUS ATROPHY (CUPPING) OF OPTIC
DISC |
| 377.15 |
PARTIAL OPTIC ATROPHY |
| 377.16 |
HEREDITARY OPTIC ATROPHY |
| 377.21 |
DRUSEN OF OPTIC DISC |
| 377.22 |
CRATER-LIKE HOLES OF OPTIC DISC |
| 377.23 |
COLOBOMA OF OPTIC DISC |
| 377.24 |
PSEUDOPAPILLEDEMA |
| 377.30 |
OPTIC NEURITIS UNSPECIFIED |
| 377.31 |
OPTIC PAPILLITIS |
| 377.32 |
RETROBULBAR NEURITIS (ACUTE) |
| 377.33 |
NUTRITIONAL OPTIC NEUROPATHY |
| 377.34 |
TOXIC OPTIC NEUROPATHY |
| 377.39 |
OTHER OPTIC NEURITIS |
| 377.41 |
ISCHEMIC OPTIC NEUROPATHY |
| 377.42 |
HEMORRHAGE IN OPTIC NERVE SHEATHS |
| 377.49 |
OTHER DISORDERS OF OPTIC NERVE |
| 377.51 |
DISORDERS OF OPTIC CHIASM ASSOCIATED WITH
PITUITARY NEOPLASMS AND DISORDERS |
| 377.52 |
DISORDERS OF OPTIC CHIASM ASSOCIATED WITH
OTHER NEOPLASMS |
| 377.53 |
DISORDERS OF OPTIC CHIASM ASSOCIATED WITH
VASCULAR DISORDERS |
| 377.54 |
DISORDERS OF OPTIC CHIASM ASSOCIATED WITH
INFLAMMATORY DISORDERS |
| 379.07 |
POSTERIOR SCLERITIS |
| 379.21 |
VITREOUS DEGENERATION |
| 379.22 |
CRYSTALLINE DEPOSITS IN VITREOUS |
| 379.23 |
VITREOUS HEMORRHAGE |
| 379.24 |
OTHER VITREOUS OPACITIES |
| 379.25 |
VITREOUS MEMBRANES AND STRANDS |
| 379.26 |
VITREOUS PROLAPSE |
| 379.29 |
OTHER DISORDERS OF VITREOUS |
| 379.32 |
SUBLUXATION OF LENS |
| 379.34 |
POSTERIOR DISLOCATION OF LENS |
| 714.0 |
RHEUMATOID ARTHRITIS |
| 714.30 |
CHRONIC OR UNSPECIFIED POLYARTICULAR
JUVENILE RHEUMATOID ARTHRITIS |
| 714.31 |
ACUTE POLYARTICULAR JUVENILE RHEUMATOID
ARTHRITIS |
| 714.32 |
PAUCIARTICULAR JUVENILE RHEUMATOID
ARTHRITIS |
| 714.33 |
MONOARTICULAR JUVENILE RHEUMATOID
ARTHRITIS |
| 743.51 |
VITREOUS ANOMALIES CONGENITAL |
| 743.52 |
FUNDUS COLOBOMA |
| 743.53 |
CHORIORETINAL DEGENERATION
CONGENITAL |
| 743.54 |
CONGENITAL FOLDS AND CYSTS OF POSTERIOR
SEGMENT |
| 743.55 |
CONGENITAL MACULAR CHANGES |
| 743.56 |
OTHER RETINAL CHANGES CONGENITAL |
| 743.57 |
SPECIFIED CONGENITAL ANOMALIES OF OPTIC
DISC |
| 743.58 |
VASCULAR ANOMALIES CONGENITAL |
| 743.59 |
OTHER CONGENITAL ANOMALIES OF POSTERIOR
SEGMENT |
| 759.5 |
TUBEROUS SCLEROSIS |
| 759.6 |
OTHER CONGENITAL HAMARTOSES NOT ELSEWHERE
CLASSIFIED |
| 759.82 |
MARFAN SYNDROME |
| 871.5 |
PENETRATION OF EYEBALL WITH MAGNETIC
FOREIGN BODY |
| 871.6 |
PENETRATION OF EYEBALL WITH (NONMAGNETIC)
FOREIGN BODY |
| V58.69 |
LONG-TERM (CURRENT) USE OF OTHER
MEDICATIONS |
| V67.51 |
FOLLOW-UP EXAMINATION FOLLOWING COMPLETED
TREATMENT WITH HIGH-RISK MEDICATION NOT ELSEWHERE
CLASSIFIED | |
Additional ICD-9-CM codes for
extended ophthalmoscopy (CPT codes 92225,
92226)
| 198.89 |
SECONDARY MALIGNANT NEOPLASM OF OTHER
SPECIFIED SITES |
| 237.70 |
NEUROFIBROMATOSIS UNSPECIFIED |
| 237.71 |
NEUROFIBROMATOSIS TYPE 1 VON
RECKLINGHAUSEN'S DISEASE |
| 237.72 |
NEUROFIBROMATOSIS TYPE 2 ACOUSTIC
NEUROFIBROMATOSIS |
| 249.00 |
SECONDARY DIABETES MELLITUS WITHOUT
MENTION OF COMPLICATION, NOT STATED AS UNCONTROLLED, OR
UNSPECIFIED |
| 249.01 |
SECONDARY DIABETES MELLITUS WITHOUT
MENTION OF COMPLICATION, UNCONTROLLED |
| 249.10 |
SECONDARY DIABETES MELLITUS WITH
KETOACIDOSIS, NOT STATED AS UNCONTROLLED, OR
UNSPECIFIED |
| 249.11 |
SECONDARY DIABETES MELLITUS WITH
KETOACIDOSIS, UNCONTROLLED |
| 249.20 |
SECONDARY DIABETES MELLITUS WITH
HYPEROSMOLARITY, NOT STATED AS UNCONTROLLED, OR
UNSPECIFIED |
| 249.21 |
SECONDARY DIABETES MELLITUS WITH
HYPEROSMOLARITY, UNCONTROLLED |
| 249.30 |
SECONDARY DIABETES MELLITUS WITH OTHER
COMA, NOT STATED AS UNCONTROLLED, OR UNSPECIFIED |
| 249.31 |
SECONDARY DIABETES MELLITUS WITH OTHER
COMA, UNCONTROLLED |
| 249.40 |
SECONDARY DIABETES MELLITUS WITH RENAL
MANIFESTATIONS, NOT STATED AS UNCONTROLLED, OR
UNSPECIFIED |
| 249.41 |
SECONDARY DIABETES MELLITUS WITH RENAL
MANIFESTATIONS, UNCONTROLLED |
| 249.60 |
SECONDARY DIABETES MELLITUS WITH
NEUROLOGICAL MANIFESTATIONS, NOT STATED AS UNCONTROLLED,
OR UNSPECIFIED |
| 249.61 |
SECONDARY DIABETES MELLITUS WITH
NEUROLOGICAL MANIFESTATIONS, UNCONTROLLED |
| 249.70 |
SECONDARY DIABETES MELLITUS WITH
PERIPHERAL CIRCULATORY DISORDERS, NOT STATED AS
UNCONTROLLED, OR UNSPECIFIED |
| 249.71 |
SECONDARY DIABETES MELLITUS WITH
PERIPHERAL CIRCULATORY DISORDERS, UNCONTROLLED |
| 249.80 |
SECONDARY DIABETES MELLITUS WITH OTHER
SPECIFIED MANIFESTATIONS, NOT STATED AS UNCONTROLLED, OR
UNSPECIFIED |
| 249.81 |
SECONDARY DIABETES MELLITUS WITH OTHER
SPECIFIED MANIFESTATIONS, UNCONTROLLED |
| 249.90 |
SECONDARY DIABETES MELLITUS WITH
UNSPECIFIED COMPLICATION, NOT STATED AS UNCONTROLLED, OR
UNSPECIFIED |
| 249.91 |
SECONDARY DIABETES MELLITUS WITH
UNSPECIFIED COMPLICATION, UNCONTROLLED |
| 250.00 |
DIABETES MELLITUS WITHOUT MENTION OF
COMPLICATION, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS
UNCONTROLLED |
| 250.01 |
DIABETES MELLITUS WITHOUT MENTION OF
COMPLICATION, TYPE I [JUVENILE TYPE], NOT STATED AS
UNCONTROLLED |
| 250.02 |
DIABETES MELLITUS WITHOUT MENTION OF
COMPLICATION, TYPE II OR UNSPECIFIED TYPE,
UNCONTROLLED |
| 250.03 |
DIABETES MELLITUS WITHOUT MENTION OF
COMPLICATION, TYPE I [JUVENILE TYPE], UNCONTROLLED |
| 250.10 |
DIABETES WITH KETOACIDOSIS, TYPE II OR
UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED |
| 250.11 |
DIABETES WITH KETOACIDOSIS, TYPE I
[JUVENILE TYPE], NOT STATED AS UNCONTROLLED |
| 250.12 |
DIABETES WITH KETOACIDOSIS, TYPE II OR
UNSPECIFIED TYPE, UNCONTROLLED |
| 250.13 |
DIABETES WITH KETOACIDOSIS, TYPE I
[JUVENILE TYPE], UNCONTROLLED |
| 250.20 |
DIABETES WITH HYPEROSMOLARITY, TYPE II OR
UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED |
| 250.21 |
DIABETES WITH HYPEROSMOLARITY, TYPE I
[JUVENILE TYPE], NOT STATED AS UNCONTROLLED |
| 250.22 |
DIABETES WITH HYPEROSMOLARITY, TYPE II OR
UNSPECIFIED TYPE, UNCONTROLLED |
| 250.23 |
DIABETES WITH HYPEROSMOLARITY, TYPE I
[JUVENILE TYPE], UNCONTROLLED |
| 250.30 |
DIABETES WITH OTHER COMA, TYPE II OR
UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED |
| 250.31 |
DIABETES WITH OTHER COMA, TYPE I
[JUVENILE TYPE], NOT STATED AS UNCONTROLLED |
| 250.32 |
DIABETES WITH OTHER COMA, TYPE II OR
UNSPECIFIED TYPE, UNCONTROLLED |
| 250.33 |
DIABETES WITH OTHER COMA, TYPE I
[JUVENILE TYPE], UNCONTROLLED |
| 250.40 |
DIABETES WITH RENAL MANIFESTATIONS, TYPE
II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED |
| 250.41 |
DIABETES WITH RENAL MANIFESTATIONS, TYPE
I [JUVENILE TYPE], NOT STATED AS UNCONTROLLED |
| 250.42 |
DIABETES WITH RENAL MANIFESTATIONS, TYPE
II OR UNSPECIFIED TYPE, UNCONTROLLED |
| 250.43 |
DIABETES WITH RENAL MANIFESTATIONS, TYPE
I [JUVENILE TYPE], UNCONTROLLED |
| 360.9 |
UNSPECIFIED DISORDER OF GLOBE |
| 364.00 |
ACUTE AND SUBACUTE IRIDOCYCLITIS
UNSPECIFIED |
| 364.01 |
PRIMARY IRIDOCYCLITIS |
| 364.02 |
RECURRENT IRIDOCYCLITIS |
| 364.03 |
SECONDARY IRIDOCYCLITIS INFECTIOUS |
| 364.04 |
SECONDARY IRIDOCYCLITIS
NONINFECTIOUS |
| 364.10 |
CHRONIC IRIDOCYCLITIS UNSPECIFIED |
| 364.11 |
CHRONIC IRIDOCYCLITIS IN DISEASES
CLASSIFIED ELSEWHERE |
| 364.21 |
FUCHS' HETEROCHROMIC CYCLITIS |
| 364.23 |
LENS-INDUCED IRIDOCYCLITIS |
| 364.41 |
HYPHEMA OF IRIS AND CILIARY BODY |
| 364.42 |
RUBEOSIS IRIDIS |
| 364.51 |
ESSENTIAL OR PROGRESSIVE IRIS
ATROPHY |
| 364.52 |
IRIDOSCHISIS |
| 364.53 |
PIGMENTARY IRIS DEGENERATION |
| 364.54 |
DEGENERATION OF PUPILLARY MARGIN |
| 364.55 |
MIOTIC CYSTS OF PUPILLARY MARGIN |
| 364.56 |
DEGENERATIVE CHANGES OF CHAMBER
ANGLE |
| 364.57 |
DEGENERATIVE CHANGES OF CILIARY
BODY |
| 364.59 |
OTHER IRIS ATROPHY |
| 364.60 |
IDIOPATHIC CYSTS OF IRIS AND CILIARY
BODY |
| 364.61 |
IMPLANTATION CYSTS OF IRIS AND CILIARY
BODY |
| 364.62 |
EXUDATIVE CYSTS OF IRIS OR ANTERIOR
CHAMBER |
| 364.63 |
PRIMARY CYST OF PARS PLANA |
| 364.64 |
EXUDATIVE CYST OF PARS PLANA |
| 364.70 |
ADHESIONS OF IRIS UNSPECIFIED |
| 364.71 |
POSTERIOR SYNECHIAE OF IRIS |
| 364.72 |
ANTERIOR SYNECHIAE OF IRIS |
| 364.73 |
GONIOSYNECHIAE |
| 364.74 |
ADHESIONS AND DISRUPTIONS OF PUPILLARY
MEMBRANES |
| 364.75 |
PUPILLARY ABNORMALITIES |
| 364.76 |
IRIDODIALYSIS |
| 364.77 |
RECESSION OF CHAMBER ANGLE OF EYE |
| 364.81 |
FLOPPY IRIS SYNDROME |
| 364.89 |
OTHER DISORDERS OF IRIS AND CILIARY
BODY |
| 364.9 |
UNSPECIFIED DISORDER OF IRIS AND CILIARY
BODY |
| 368.46 |
HOMONYMOUS BILATERAL FIELD DEFECTS |
| 368.47 |
HETERONYMOUS BILATERAL FIELD
DEFECTS |
| 368.60 |
NIGHT BLINDNESS UNSPECIFIED |
| 368.61 |
CONGENITAL NIGHT BLINDNESS |
| 368.62 |
ACQUIRED NIGHT BLINDNESS |
| 368.63 |
ABNORMAL DARK ADAPTATION CURVE |
| 368.69 |
OTHER NIGHT BLINDNESS |
| 376.40 |
DEFORMITY OF ORBIT UNSPECIFIED |
| 376.41 |
HYPERTELORISM OF ORBIT |
| 376.42 |
EXOSTOSIS OF ORBIT |
| 376.43 |
LOCAL DEFORMITIES OF ORBIT DUE TO BONE
DISEASE |
| 376.44 |
ORBITAL DEFORMITIES ASSOCIATED WITH
CRANIOFACIAL DEFORMITIES |
| 376.45 |
ATROPHY OF ORBIT |
| 376.46 |
ENLARGEMENT OF ORBIT |
| 376.47 |
DEFORMITY OF ORBIT DUE TO TRAUMA OR
SURGERY |
| 376.50 |
ENOPHTHALMOS UNSPECIFIED AS TO
CAUSE |
| 376.51 |
ENOPHTHALMOS DUE TO ATROPHY OF ORBITAL
TISSUE |
| 376.52 |
ENOPHTHALMOS DUE TO TRAUMA OR
SURGERY |
| 376.6 |
RETAINED (OLD) FOREIGN BODY FOLLOWING
PENETRATING WOUND OF ORBIT |
| 871.7 |
UNSPECIFIED OCULAR PENETRATION |
| 871.9 |
UNSPECIFIED OPEN WOUND OF EYEBALL |
| 921.3 |
CONTUSION OF EYEBALL |
| 958.1 |
FAT EMBOLISM AS AN EARLY COMPLICATION OF
TRAUMA |
| 995.50 |
UNSPECIFIED CHILD ABUSE |
| 995.51 |
CHILD EMOTIONAL/PSYCHOLOGICAL ABUSE |
| 995.52 |
CHILD NEGLECT (NUTRITIONAL) |
| 995.53 |
CHILD SEXUAL ABUSE |
| 995.54 |
CHILD PHYSICAL ABUSE |
| 995.55 |
SHAKEN BABY SYNDROME |
| 995.59 |
OTHER CHILD ABUSE AND
NEGLECT | |
Additional ICD-9-CM codes for fundus
photography (CPT codes 92228,
92250)
| 042 |
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
DISEASE |
| 094.85 |
SYPHILITIC RETROBULBAR NEURITIS |
| 115.01 |
HISTOPLASMA CAPSULATUM MENINGITIS |
| 115.12 |
HISTOPLASMA DUBOISII RETINITIS |
| 115.90 |
HISTOPLASMOSIS UNSPECIFIED WITHOUT
MANIFESTATION |
| 115.91 |
HISTOPLASMOSIS MENINGITIS
UNSPECIFIED |
| 115.93 |
HISTOPLASMOSIS PERICARDITIS
UNSPECIFIED |
| 115.94 |
HISTOPLASMOSIS ENDOCARDITIS |
| 115.95 |
HISTOPLASMOSIS PNEUMONIA
UNSPECIFIED |
| 115.99 |
HISTOPLASMOSIS UNSPECIFIED WITH OTHER
MANIFESTATION |
| 130.1 |
CONJUNCTIVITIS DUE TO TOXOPLASMOSIS |
| 190.1 |
MALIGNANT NEOPLASM OF ORBIT |
| 190.2 |
MALIGNANT NEOPLASM OF LACRIMAL
GLAND |
| 190.3 |
MALIGNANT NEOPLASM OF CONJUNCTIVA |
| 190.4 |
MALIGNANT NEOPLASM OF CORNEA |
| 190.7 |
MALIGNANT NEOPLASM OF LACRIMAL DUCT |
| 190.8 |
MALIGNANT NEOPLASM OF OTHER SPECIFIED
SITES OF EYE |
| 190.9 |
MALIGNANT NEOPLASM OF EYE PART
UNSPECIFIED |
| 198.4 |
SECONDARY MALIGNANT NEOPLASM OF OTHER
PARTS OF NERVOUS SYSTEM |
| 224.0 |
BENIGN NEOPLASM OF EYEBALL EXCEPT
CONJUNCTIVA CORNEA RETINA AND CHOROID |
| 234.0 |
CARCINOMA IN SITU OF EYE |
| 238.8 |
NEOPLASM OF UNCERTAIN BEHAVIOR OF OTHER
SPECIFIED SITES |
| 239.81* |
NEOPLASMS OF UNSPECIFIED NATURE, RETINA
AND CHOROID |
| 239.89* |
NEOPLASMS OF UNSPECIFIED NATURE, OTHER
SPECIFIED SITES |
| 270.2 |
OTHER DISTURBANCES OF AROMATIC AMINO-ACID
METABOLISM |
| 282.60 |
SICKLE-CELL DISEASE UNSPECIFIED |
| 282.61 |
HB-SS DISEASE WITHOUT CRISIS |
| 282.62 |
HB-SS DISEASE WITH CRISIS |
| 282.63 |
SICKLE-CELL/HB-C DISEASE WITHOUT
CRISIS |
| 282.64 |
SICKLE-CELL/HB C DISEASE WITH
CRISIS |
| 282.68 |
OTHER SICKLE-CELL DISEASE WITHOUT
CRISIS |
| 282.69 |
OTHER SICKLE-CELL DISEASE WITH
CRISIS |
| 340 |
MULTIPLE SCLEROSIS |
| 362.9 |
UNSPECIFIED RETINAL DISORDER |
| 368.51 |
PROTAN DEFECT |
| 368.52 |
DEUTAN DEFECT |
| 368.53 |
TRITAN DEFECT |
| 368.54 |
ACHROMATOPSIA |
| 368.55 |
ACQUIRED COLOR VISION DEFICIENCIES |
| 368.59 |
OTHER COLOR VISION DEFICIENCIES |
| 377.43 |
OPTIC NERVE HYPOPLASIA |
| 377.61 |
DISORDERS OF OTHER VISUAL PATHWAYS
ASSOCIATED WITH NEOPLASMS |
| 377.62 |
DISORDERS OF OTHER VISUAL PATHWAYS
ASSOCIATED WITH VASCULAR DISORDERS |
| 377.63 |
DISORDERS OF OTHER VISUAL PATHWAYS
ASSOCIATED WITH INFLAMMATORY DISORDERS |
| 377.71 |
DISORDERS OF VISUAL CORTEX ASSOCIATED
WITH NEOPLASMS |
| 377.72 |
DISORDERS OF VISUAL CORTEX ASSOCIATED
WITH VASCULAR DISORDERS |
| 377.73 |
DISORDERS OF VISUAL CORTEX ASSOCIATED
WITH INFLAMMATORY DISORDERS |
| 377.75 |
CORTICAL BLINDNESS |
| 377.9 |
UNSPECIFIED DISORDER OF OPTIC NERVE AND
VISUAL PATHWAYS |
| 379.00 |
SCLERITIS UNSPECIFIED |
| 379.09 |
OTHER SCLERITIS |
| 379.11 |
SCLERAL ECTASIA |
| 695.4 |
LUPUS ERYTHEMATOSUS |
| 710.0 |
SYSTEMIC LUPUS ERYTHEMATOSUS |
| 714.1 |
FELTY'S SYNDROME |
| 714.2 |
OTHER RHEUMATOID ARTHRITIS WITH VISCERAL
OR SYSTEMIC INVOLVEMENT |
| 714.4 |
CHRONIC POSTRHEUMATIC ARTHROPATHY |
| 714.81 |
RHEUMATOID LUNG |
| 714.89 |
OTHER SPECIFIED INFLAMMATORY
POLYARTHROPATHIES |
| 714.9 |
UNSPECIFIED INFLAMMATORY
POLYARTHROPATHY |
| 759.81 |
PRADER-WILLI SYNDROME |
| 759.83 |
FRAGILE X SYNDROME |
| 759.89 |
OTHER SPECIFIED CONGENITAL
ANOMALIES |
| 771.0 |
CONGENITAL RUBELLA |
| 794.11 |
NONSPECIFIC ABNORMAL RETINAL FUNCTION
STUDIES |
| 794.12 |
NONSPECIFIC ABNORMAL ELECTRO-OCULOGRAM
(EOG) |
| 794.13 |
NONSPECIFIC ABNORMAL VISUALLY EVOKED
POTENTIAL |
| 794.14 |
NONSPECIFIC ABNORMAL OCULOMOTOR
STUDIES |
| 961.4 |
POISONING BY ANTIMALARIALS AND DRUGS
ACTING ON OTHER BLOOD PROTOZOA |
| 995.54 |
CHILD PHYSICAL ABUSE |
| 995.55 |
SHAKEN BABY SYNDROME |
| 995.59 |
OTHER CHILD ABUSE AND NEGLECT |
| *For dates of service prior to
October 1, 2009, ICD-9 code 239.8 is in effect. On or
after October 1, 2009, ICD-9 codes 239.81 and 239.89
replace
239.8. | | |
| |
| Diagnoses that Support
Medical Necessity |
| Not applicable |
| |
| ICD-9 Codes that DO NOT
Support Medical Necessity |
Not
applicable
|
| |
| ICD-9 Codes that DO NOT
Support Medical Necessity Asterisk Explanation |
| |
| |
| Diagnoses that DO NOT
Support Medical Necessity |
| Not
applicable | |
General Information |
|
|
| Documentation
Requirements |
Fundus photography
The patient's
medical record must contain documentation that fully supports the
medical necessity for fundus photography as it is covered by
Medicare. (See "Indications and Limitations of Coverage.") This
documentation includes, but is not limited to, relevant medical
history, physical examination, and results of pertinent diagnostic
tests or procedures.
A copy of the fundus photographs must be
retained in the patient's medical records. An interpretation and
report of the test must also be included, in addition to the
photographs themselves.
The medical record should document
whether the pupil was dilated, and which drug was
used.
Documentation supporting the medical necessity should
be legible, maintained in the patient's record, and must be
available to the carrier upon request.
Extended
ophthalmoscopy
The patient's medical record must contain
documentation that fully supports the medical necessity for extended
ophthalmoscopy for each eye, as it is covered by Medicare. (See
"Indications and Limitations of Coverage.") This documentation
includes, but is not limited to, relevant medical history, physical
examination, and results of pertinent diagnostic tests or
procedures.
Retinal drawings meeting the specifications
indicated in the attached Appendix A of this policy must be
maintained in the patient's record.
- There must be a separate detailed sketch, minimal size of 3-4
inches.
- All items noted must be identified and labeled.
- Drawings in four (4) - six (6) standard colors are preferred.
However, non-colored drawings are also acceptable, if clearly
labeled.
- Optic nerve abnormalities should be separately drawn.
- An extensive scaled drawing must accurately represent normal,
abnormal and common findings such as: lattice degeneration,
hypertensive vascular changes, proliferative diabetic retinopathy,
as well as retinal detachments, holes, tears or
tumors.
Documentation in the patient’s medical record for a
diagnosis of glaucoma (ICD-9-CM codes 365.00-365.9) must include all
of the following:
- A separate detailed drawing of the optic nerve along with an
interpretation that affects the plan of treatment,
- Documentation of cupping, disc rim, pallor, and slope,
- Documentation of any surrounding pathology around the optic
nerve.
Documentation specific to the method of examination
(e.g., lens, scleral depression, instrument used) should be
maintained in the medical record.
The medical record should
document whether the pupil was dilated, and which drug was
used.
All findings and a plan of action should be documented
in notes.
Although routine ophthalmoscopy and biomicroscopy
are part of an ophthalmologic examination and are not separately
payable, these should still be documented in the patient's medical
record.
Documentation supporting the medical necessity should
be legible, maintained in the patient's record, and must be
available to the carrier upon request. |
| |
| Appendices |
| See attachment |
| |
| Utilization
Guidelines |
Patients actively being treated with
intravitreal injections of medication for exudative AMD (ICD-9-CM
code 362.52) may require up to 12 extended ophthalmoscopies per eye,
per year.
Conditions coded with other ICD-9-CM codes in the
range 360.0-365.9, may require up to six (6) extended
ophthalmoscopic examinations per eye, per year.
For ICD-9-CM
codes 190.0, 190.5, 190.6, 198.89, 224.5 and 224.6, up to four (4)
extended ophthalmoscopic examinations may be required per eye, per
year.
Other conditions usually require no more than two (2)
extended ophthalmoscopic examinations per eye, per
year.
Extended ophthalmoscopy is a physician service
(examination of the eye) commonly occurring during the global
post-operative period of ophthalmic surgery. As a physician service,
it is included in the aftercare of the patient and is not separately
billable.
Fundus photography is usually medically necessary
no more than two times per year.
Fundus photography of a
normal retina will be considered not medically
necessary.
Services exceeding these parameters will be
considered not medically necessary. |
| |
| Sources of Information and
Basis for Decision |
This bibliography presents those sources
that were obtained during the development of this policy. National
Government Services is not responsible for the continuing viability
of Web site addresses listed below.
Fundus
photography
Bakri SJ, Sculley L, Sing AD. Imaging
techniques for uveal melanoma. Int Ophthalmol Clin.
2006;46(1):1-13. Available
at
http://gateway.ut.ovid.com.proxy.medlib.iupui.edu/qw2/ovidweb.cgi.
Accessed November 15, 2006.
Mayfeild J. Who cares about the
quality of diabetes care? Almost everyone! Clinical Diabetes.
1998;16(4). Available at
http://journal.diabetes.org/clinicaldiabetes/v16n41998/Mayfield.htm.
Accessed July 21, 2006.
National Guideline Clearinghouse.
Age-related macular degeneration. Limited revision.
www.guideline.gov. Accessed July 21, 2006.
National Guideline
Clearinghouse. Care of the patient with diabetes mellitus. 3rd
edition. www.guideline.gov. Accessed July 21, 2006.
National
Guideline Clearinghouse. Care of the patient with retinal detachment
and related peripheral vitreoretinal disease. Available at:
www.guideline.gov. Accessed July 21, 2006.
Other carrier
policy (Empire Medical Services [effective 06/01/1996] L682).
Available at:
http://www.cms.hhs.gov/mcd/results.asp?show=all&t=200647152649 .
Accessed July 21, 2006.
Other carrier policy (Empire Medical
Services [effective 10/01/2005] L3634 R5). Available at:
http://www.cms.hhs.gov/mcd/results.asp?show=all&t=200647152649 .
Accessed July 21, 2006.
Other carrier policy (First Coast
Service Options [effective 10/30/2006] L18148 R1). Available at:
http://www.cms.hhs.gov/mcd/results.asp?show=all&t=200647152649 .
Accessed December 8, 2006.
Singh RP, Young LH. Diagnostic
tests for posterior segment inflammation. Int Ophthalmol
Clin. 2006;46(2):195-208. Available at
http://gateway.ut.ovid.com.proxy.medlib.iupui.edu/qw2/ovidweb.cgi.
Accessed November 15, 2006.
Extended
ophthalmoscopy
Carrier Medical Director, BCBS,
Kansas.
Comments from American Academy of
Ophthalmology.
Comments from New York State Ophthalmology CAC
representative.
Comments from New York State Optometric
Association.
Comments from practicing
ophthalmologists.
Comments from retinal
consultants.
Consultants in Optometry (New
Jersey).
CPT editorial staff.
Duane's Clinical
Ophthalmology, J. B. Lippincott Co.; 1994.
Essentials
of Ophthalmology, Editors Bartley and Liesegang, J.B. Lippincott
Co.;1992.
Focus panel of invited
ophthalmologists/optometrists convened October 11, 2000 in New York.
Guyer DR, Yannuzzi LA, Chang, S, Shields JA, Green WR.
Retina vitreous macula, clinical examination of the posterior
segment of the eye. W.B. Saunders Company;
1999:21-28.
HCFA Regional Office reimbursement
specialist.
Jones WL, Reidy RW. Atlas of the peripheral
ocular fundus. Butterworth Publishers; 1985:1-4.
McPhee
S,Papadakis M, Tierney L. Current medical diagnosis and
treatment. Stanford: Appleton and Lange; 1996.
Newell F.
Ophthalmology-principles and concepts. St. Louis: Mosby;
1992.
Other Carrier Policies:
First Coast Service Options,
Inc. - Florida – Database # L6030 (12/18/1995)
Trailblazer
Health Enterprises, LLC – Texas – Database # L8867
(11/05/1996)
Additional sources used in reconsideration
request for September 1, 2009 revision:
Bresnick GH, Mukaamel
DB, Dickinson JC, Cole DR. A screening approach to the surveillance
of patients with diabetes for the presence of vision-threatening
retinopathy. Ophthalmology. 2000;107:19-24.
Hutchinson
A, McIntosh A, Peters J, et al. Effectiveness of screening and
monitoring tests for diabetic retinopathy – a systemic review.
Diabetes Medicine. 2000;17:495-506.
Personal
communications, CMS Coverage and Analysis Group, Marcel Salive, MD,
Louis Jacques, MD and Ross Brechner, MD.
Williams GA, Scott
IU, Haller JA, et al. Single-field fundus photography for diabetic
retinopathy screening. Ophthalmology.
2004;111:1055-1062. |
| |
| Advisory Committee Meeting
Notes |
Carrier Advisory Committee Meeting
Date(s):
06/13/2007 - NewYork/New Jersey
06/25/2007 –
Indiana
06/28/2007 - Kentucky
This coverage determination
does not reflect the sole opinion of the contractor or contractor
medical director. Although the final decision rests with the
contractor, this determination is developed in consultation with
representatives from Advisory Committee members and/or from various
state and local provider organizations.
Any Carrier Advisory
Committee (CAC) related information, including Start Date and End
Date of Comment Period, reflects the last time this LCD passed
through the Comment and Notice process. Formal comment is not
required for LCDs being adopted as part of the MAC
transition. |
| |
| Start Date of Comment
Period |
| 06/01/2007 |
| |
| End Date of Comment
Period |
| 07/16/2007 |
| |
| Start Date of Notice
Period |
| 01/01/2011 |
| |
| Revision History
Number |
| R6 |
| |
| Revision History
Explanation |
R6 (effective 01/01/2011):
LCD revised for annual HCPCS updates. CPT code 92227 added as
non-covered (screening) and CPT code 92228 added under coverage
criteria for fundus photography. Minor template changes made. No
comment or notice periods required and none given.
R5
(effective 04/01/2010): Bill type instructions for reporting FQHC
services updated to add bill type 77X. Minor template changes made.
No comment or notice periods required and none given.
R4
(Effective 09/01/2009): Source of revision – Reconsideration
request. ICD-9 codes 368.11-368.16, 368.40-368.45, 368.8 and 368.9
moved from list of payable diagnoses for extended ophthalmoscopy to
list of payable diagnoses for extended ophthalmoscopy AND fundus
photography; Indications section updated with addititional coverage
criteria related to fundus photography for diabetic patients;
Limitations section updated with additional criteria on fundus
photography used for screening; Sources of Information updated with
sources used in reconsideration request.
Based on annual
ICD-9 updates, effective for dates of service on or after October 1,
2009, ICD-9 code 239.8 is replaced by codes 239.81 and 239.89 as
payable for fundus photography. No comment and notice periods
required and none given.
08/08/2009 - This policy was updated
by the ICD-9 2009-2010 Annual Update.
06/05/2009 - In
accordance with Section 911 of the Medicare Modernization Act of
2003, fiscal intermediary number 00270 was removed from this LCD as
the claims processing for New Hampshire and Vermont was transitioned
to NHIC, the Part A/Part B MAC contractor in these
states.
R3(Effective 03/01/2009): Source of revision –
Internal. Abstract expanded; minor formatting changes
made.
05/15/2009 - In accordance with Section 911 of the
Medicare Modernization Act of 2003, fiscal intermediary numbers
00180 and 00181 were removed from this LCD as the claims processing
for Maine and Massachusetts was transitioned to NHIC, the Part
A/Part B MAC contractor in these states.
11/14/2008 - In
accordance with Section 911 of the Medicare Modernization Act of
2003, fiscal intermediary number 00308 is removed from this LCD.
Effective on this date, claims processing for Delaware is performed
by Highmark Medicare Services, the Part A/Part B MAC contractor for
this state, and the claims processing for New York and Connecticut
is performed by National Government Services under the J-13 MAC
contract; carrier number 00805 is removed, and claims processing for
New Jersey is performed by Highmark Medicare Services, the Part
A/Part B MAC contractor for this state.
11/01/2008: Corrected
version of policy published 10/01/2008 with no change in the
revision effective date of 10/01/2008. ICD-9-CM code 362.29 was
omitted in error from ICD-9-CM codes for Fundus Photography and
Extended Ophthalmoscopy.
R2(Effective 10/01/2008): Source of
revision – Internal: Annual ICD-9-CM update:
added codes 249.50, 249.51, 362.20, 362.22-362.27, and 362.82 as
payable for CPT codes 92225, 92226 and 92250; added codes 249.00,
249.01, 249.10, 249.11, 249.20, 249.21, 249.30, 249.31, 249.40,
249.41, 249.60, 249.61, 249.70, 249.71, 249.80, 249.81, 249.90, and
249.91 as payable for CPT codes 92225 and 92226.
08/18/2008 -
In accordance with Section 911 of the Medicare Modernization Act of
2003, fiscal intermediary number 00454 was removed from this LCD as
the claims processing for American Samoa, California, Guam, Hawaii,
Nevada and Northern Mariana Islands was transitioned to Palmetto
GBA, the Part A/Part B MAC contractor in these states.
R1:
This revised LCD is effective for all National Government Services
jurisdictions on July 18, 2008 with these exceptions: for
Connecticut – Part B the LCD is effective on August 1, 2008; for
Upstate New York – Part B, the LCD is effective on September 1,
2008; and for New York and Connecticut – Part A, the LCD is
effective on November 14, 2008. For New York – Part A (contract
00308), the content of this LCD is currently in effect but the LCD
will be transferred to the J-13 contract number 13201 on November
14, 2008.
This LCD was revised to add the Jurisdiction 13
(J-13) MAC contractor numbers.
The CMS Statement of Work for
the J13 Medicare Administrative Contract (MAC) requires that the
contractor retain the most clinically appropriate LCD within the
jurisdiction. This NGS policy is being promulgated to the J13 MAC as
the most clinically appropriate LCD within that jurisdiction.
The NGS roster of LCDs has been developed under the combined
experience of seven Medicare contractor medical directors. The
criteria for inclusion in this roster includes areas of identified
CERT errors, especially repetitive errors; high volume/high
dollar/pervasive problems; patient safety issues; potential for
automation; beneficiary access to new technology; implementation of
NCD; narrative medical necessity parameters for medical review and
provider education; and CMS/law enforcement mandates.
NGS
LCDs have undergone an advice and comment process from the providers
in 23 states. This advice and comment process, the most
comprehensive among all Medicare contractors, has ensured that NGS
policies have benefited from the most in-depth and scientifically
rigorous scrutiny. The NGS policy development process has resulted
in the most clinically appropriate LCDs for providers and Medicare
beneficiaries.
3/7/2010 - The description for Bill Type Code
73 was changed
8/1/2010 - The description for Bill Type Code
12 was changed
8/1/2010 - The description for Bill Type Code 13
was changed
8/1/2010 - The description for Bill Type Code 21 was
changed
8/1/2010 - The description for Bill Type Code 71 was
changed
8/1/2010 - The description for Bill Type Code 73 was
changed
8/1/2010 - The description for Bill Type Code 85 was
changed
8/1/2010 - The description for Revenue code 0409 was
changed
8/1/2010 - The description for Revenue code 0450 was
changed
8/1/2010 - The description for Revenue code 0510 was
changed
8/1/2010 - The description for Revenue code 0511 was
changed
8/1/2010 - The description for Revenue code 0512 was
changed
8/1/2010 - The description for Revenue code 0513 was
changed
8/1/2010 - The description for Revenue code 0514 was
changed
8/1/2010 - The description for Revenue code 0515 was
changed
8/1/2010 - The description for Revenue code 0516 was
changed
8/1/2010 - The description for Revenue code 0517 was
changed
8/1/2010 - The description for Revenue code 0519 was
changed
8/1/2010 - The description for Revenue code 0520 was
changed
8/1/2010 - The description for Revenue code 0521 was
changed
8/1/2010 - The description for Revenue code 0522 was
changed
8/1/2010 - The description for Revenue code 0523 was
changed
8/1/2010 - The description for Revenue code 0524 was
changed
8/1/2010 - The description for Revenue code 0525 was
changed
8/1/2010 - The description for Revenue code 0526 was
changed
8/1/2010 - The description for Revenue code 0527 was
changed
8/1/2010 - The description for Revenue code 0528 was
changed
8/1/2010 - The description for Revenue code 0529 was
changed
8/1/2010 - The description for Revenue code 0962 was
changed
11/21/2010 - For the following CPT/HCPCS codes either
the short description and/or the long description was changed.
Depending on which description is used in this LCD, there may not be
any change in how the code displays in the document:
92225
descriptor was changed in Group 1
92226 descriptor was changed in
Group 1 |
| |
| Reason for
Change |
HCPCS Addition/Deletion
|
| Last Reviewed On
Date |
| 01/01/2011 |
| |
| Related
Documents |
Article(s)
A44439 - Ophthalmology: Posterior Segment Imaging
(Extended Ophthalmoscopy and Fundus Photography) – Supplemental
Instructions Article
|
| |
| LCD
Attachments |
|
| |
|