H34.239 — Retinal artery branch occlusion, unspecified eye
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.
- The patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
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.
- Panretinal (scatter) laser photocoagulation (PRP) is covered when medically necessary and supported by the Local Coverage Determination (LCD) and the patient's medical record.
- Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
- Non-invasive extracranial arterial studies are covered only when the service meets all clinical indications and limitations specified in LCD L33695 and all applicable CMS national coverage determinations and Medicare medical necessity requirements.
- Panretinal laser photocoagulation is indicated for treatment or management of proliferative diabetic retinopathy.
- Panretinal laser photocoagulation is indicated for treatment or management of pre-proliferative diabetic retinopathy.
8 Active Policies
A56537 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J06
A56550 — Billing and Coding: Panretinal (Scatter) Laser Photocoagulation
J06
L34380 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J06
L33628 — Panretinal (Scatter) Laser Photocoagulation
J06
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.