G92.9 — Unspecified toxic encephalopathy
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- When the service is performed in a hospital inpatient or outpatient setting, use modifier -26 to indicate the professional component.
- Billing and coding must adhere to the coverage indications, limitations, and medical necessity criteria described in the associated LCD L34615 Visual Fields; follow that LCD for clinical eligibility and documentation requirements.
- Prior to billing Medicare, verify applicable code combinations and correct coding guidelines with the CCI (Correct Coding Initiative).
- Documentation should record the affected eye(s) because visual field testing is performed and billed separately for each eye.
Key Coverage Criteria
- Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
- Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).
- The technical component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), Independent Clinic (49), Federally Qualified Health Center (50), and Rural Health Clinic (72).
- The professional component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Off-campus Outpatient Hospital (19), Inpatient Hospital (21), On-campus Outpatient Hospital (22), Emergency Room (23), Skilled Nursing Facility (31), Nursing Facility (32), Independent Clinic (49), and Comprehensive Outpatient Rehabilitation Facility (62).
- Visual field testing is medically necessary when a pale or swollen optic nerve is documented on recent examination.
- Visual field testing is medically necessary for a documented diagnosis of glaucoma to monitor stabilization or progression of disease.
4 Active Policies
A57483 — Billing and Coding: Visual Fields
J05
L34615 — Visual Fields
J05
AETNA-CPB-0214 — Cognitive Rehabilitation
AETNA-CPB-0221 — Quantitative EEG (Brain Mapping)
Related Codes
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