H40.1290 — Low-tension glaucoma, unspecified eye, stage unspecified
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
- SCODI (CPT 92133, 92134) is considered medically reasonable and necessary for evaluation of retinal disorders, glaucoma, and anterior segment disorders as documented in LCD L34760.
- 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.
6 Active Policies
A56916 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J05
L34760 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J05
A57637 — Billing and Coding: Visual Field Examination
J09
L33766 — Visual Field Examination
J09
A56457
Related Codes
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