H53.129 — Transient visual loss, unspecified eye
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information such as complete name and dates of service.
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
- The submitted medical record must support the use of the selected ICD-10-CM code(s).
Key Coverage Criteria
- 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.
- Evaluation is covered for patients with vasculitis involving the extracranial carotid arteries.
- Evaluation is covered for patients with proven carotid disease on medical management whose cerebrovascular symptoms become recurrent.
- Evaluation is covered for patients presenting with carotid artery injury or blunt neck trauma.
- Initial non-invasive extracranial arterial study is covered for an asymptomatic carotid bruit identified on physical examination.
4 Active Policies
A57637 — Billing and Coding: Visual Field Examination
J09
A57670 — Billing and Coding: Non-invasive Extracranial Arterial Studies
J09
L33695 — Non-invasive Extracranial Arterial Studies
J09
L33766 — Visual Field Examination
J09
Related Codes
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