H40.2294 — Chronic angle-closure glaucoma, unspecified eye, indeterminate stage
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Document general ophthalmoscopy and biomicroscopy findings in the medical record even when these services are included in extended ophthalmoscopy and not separately billed.
- For extended ophthalmoscopy, include a drawing or equivalent documentation that demonstrates the extended nature of the exam to support separate payment.
- Orders for CPT 92227 and CPT 92228 must be from the treating physician or other treating practitioner acting within the scope of license and Medicare requirements and this order must be documented in the record.
- When extended ophthalmoscopy is performed during a global surgery period and is unrelated to the surgical condition, document the unrelatedness and report modifier -76 or -79 as appropriate.
Key Coverage Criteria
- Extended ophthalmoscopy (CPT 92201, 92202) is payable when documented as an extended ophthalmoscopy that meets indicated standards (e.g., includes a retinal drawing or equivalent documentation) beyond a general ophthalmologic exam.
- Fundus photography (CPT 92227, CPT 92228) is covered when ordered by the treating physician or other treating practitioner acting within the scope of his/her license and Medicare requirements.
- CPT 92227 is covered when used to evaluate asymptomatic patients at risk with known disease likely to cause retinal disease (e.g., diabetes mellitus) when ordered by the treating physician.
- CPT 92228 is a covered service when ordered by the treating physician or other treating practitioner acting within the scope of license and Medicare requirements.
- Ophthalmic biometry using CPT 76519 (A-scan) or CPT 92136 (optical coherence biometry) is payable under Medicare Part B when performed for intraocular lens (IOL) power calculation.
- The global service (76519 or 92136 global) is payable in the office (place of service 11) and independent clinic (49).
8 Active Policies
L33766 — Visual Field Examination
J09
A57637 — Billing and Coding: Visual Field Examination
J09
A57070 — Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation
L34181 — Ophthalmic Biometry for Intraocular Lens Power Calculation
L33467 — Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Related Codes
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