H16.331 — Sclerosing keratitis, right eye
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For diagnostic tests, report the test result on the claim if known; if the result is not known at time of billing, report the symptoms that prompted the test.
- The patient medical record must include the ordering provider's assessment related to the patient's complaint, relevant medical history, and results of pertinent tests/procedures.
- For services requiring a referring/ordering physician, the claim must report the referring/ordering physician's name and NPI.
- All services ordered or rendered to Medicare beneficiaries must be signed and dated; include a signed and dated office visit record or operative report in the medical record.
Key Coverage Criteria
- Computerized corneal topography is billable when performed as a diagnostic test for corneal conditions and the claim includes a diagnosis code that best describes the patient's condition for which the service was performed.
- External ocular photography is covered when ordered by an authorized/referring provider to document, diagnose, or monitor an ocular condition and when medical record documentation supports medical necessity.
- External ocular photographs are covered to track changes in a patient's ocular condition provided changes are documented in writing and compared to prior photographs when available.
- Technical (TC) and professional (26) components of external ocular photography are payable under Part B when billed with the appropriate modifier and performed in allowable places of service as specified by Medicare.
- 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.
7 Active Policies
A57637 — Billing and Coding: Visual Field Examination
J09
L33766 — Visual Field Examination
J09
A57068 — Billing and Coding: Ocular Photography - External
AMBETTER-CP.VP.43 — External Ocular Photography
L34393 — Ocular Photography - External
Related Codes
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