H11.159 — Pinguecula, unspecified eye
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Interpretation and report accompanying external ocular photography (consistent with CPT 92285: 'External ocular photography with interpretation and report for documentation of medical progress').
- Clinical documentation demonstrating that photographs are being used to track and serially compare changes in the condition and that the photographic results may impact patient management and clinical outcomes.
- Documentation that selection criteria (medical necessity indications listed in the policy) are met for the performed photography.
- Records of the images (prints, slides, videotape or digital medium) and their storage as part of the medical record are acceptable.
Key Coverage Criteria
- Acute inflammation of orbit, unspecified
- Adherent leucoma
- Argentous deposits
- Benign neoplasm of conjunctiva
- Adhesions of iris, unspecified
- Corneal edema due to wearing of contact
1 Active Policy
AETNA-CPB-0734 — External Ocular Photography
Related Codes
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