D09.20 — Carcinoma in situ of unspecified eye
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This article provides billing and coding guidelines that complement Local Coverage Determination (LCD) L37176 for White Cell Colony Stimulating Factors; refer to LCD L37176 for specific coverage criteria, indications, and limitations.
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information such as complete name and dates of service.
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
Key Coverage Criteria
- Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
- Destruction of a skin lesion is covered only when the medical record documents the lesion as malignant by a corresponding pathology report or a clinical description consistent with skin malignancy.
- The medical record must include lesion size and lesion location to support medical necessity for destruction of a malignant skin lesion.
- Services are covered only when they meet all applicable indications and limitations in LCD L33813, CMS payment policy manuals, any relevant national coverage determinations, and Medicare payment rules.
- Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
- Visual field examination is covered for patients with inflammation or disorders of the eyelids that may affect the visual field.
9 Active Policies
A57637 — Billing and Coding: Visual Field Examination
J09
L33766 — Visual Field Examination
J09
A57638 — Billing and Coding: Destruction of Malignant Skin Lesions
A57788 — Billing and Coding: Peripheral Nerve Blocks
L33933 — Peripheral Nerve Blocks
Related Codes
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