H18.461 — Peripheral corneal degeneration, right eye
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The medical record must include the ordering provider's assessment relevant to the patient's complaint for that visit.
- The medical record must include relevant medical history related to the service.
- The medical record must include results of pertinent tests and procedures; for diagnostic tests report the actual test result if known, otherwise report the symptoms prompting the test.
- All office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.
Key Coverage Criteria
- Corneal pachymetry (measurement of corneal thickness) is covered to evaluate patients with a diagnosis of increased intraocular pressure.
- Repeat corneal pachymetry is covered after interval corneal trauma or corneal surgery to reassess corneal thickness.
- Corneal pachymetry is generally covered when performed as indicated by current medical literature or accepted standards of practice for clinical management.
- 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.
14 Active Policies
A57483 — Billing and Coding: Visual Fields
J05
L34615 — Visual Fields
J05
A56548 — Billing and Coding: Corneal Pachymetry
J06
L33630 — Corneal Pachymetry
J06
L33766 — Visual Field Examination
Related Codes
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