H40.40X0 — Glaucoma secondary to eye inflammation, unspecified eye, stage unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Include relevant medical history in the medical record that supports the need for the visual field test.
- The medical record must include the ordering provider’s assessment related to the patient’s complaint for the visit when visual field testing is ordered.
- Include results of pertinent tests and procedures in the medical record; for diagnostic tests, include the test result if known or the symptom prompting the test.
- A signed and dated office visit record or operative report must be in the medical record for services ordered or rendered to Medicare beneficiaries.
Key Coverage Criteria
- Visual field testing is covered when billed to the Part A or Part B MAC with a valid ICD-10-CM diagnosis code that best describes the patient’s condition and when the service is reasonable and necessary.
- For diagnostic visual field tests, report the test result on the claim if known; if the result is not known, report the signs or symptoms that prompted the test.
- If the service requires a referring/ordering physician, include the ordering/referring physician’s name and NPI on the claim.
- 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.
9 Active Policies
L33766 — Visual Field Examination
J09
A57637 — Billing and Coding: Visual Field Examination
J09
A57068 — Billing and Coding: Ocular Photography - External
A57071 — Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
ANTHEM-CG-SURG-100 — CG-SURG-100 Laser Trabeculoplasty and Laser Peripheral Iridotomy
Related Codes
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