H05.819 — Cyst of unspecified orbit
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
- The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Key Coverage Criteria
- Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
- Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
- Visual field examination is covered for patients with inflammation or disorders of the eyelids that may affect the visual field.
- Visual field examination is covered for patients with a documented diagnosis of glaucoma.
- Visual field examination is covered for glaucoma suspects, defined by increased intraocular pressure, inter-eye intraocular pressure asymmetry greater than 2–3 mm Hg, or optic nerve findings suspicious for glaucoma (asymmetric cupping, disc hemorrhage, absent or thinned temporal rim).
- Visual field examination is covered for patients with a documented disorder of the optic nerve, neurologic visual pathway, or retina.
4 Active Policies
A56537 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J06
L34380 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J06
A57637 — Billing and Coding: Visual Field Examination
J09
L33766 — Visual Field Examination
J09
Related Codes
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