I67.9 — Cerebrovascular disease, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- When billing these procedures after carotid endarterectomy, include the surgery date and the phrase 'carotid endarterectomy' in the claim narrative.
- When reporting a reduced (unilateral/limited) service, append modifier -52 and include an explanation of the reduced service in Item 19 of the CMS-1500 form or electronic equivalent; any appropriate supporting documentation may be submitted with the claim.
- Follow Novitas LCD L35397 for the reasonable and necessary documentation requirements and frequency limitations, and consult NCCI edits for correct coding combinations prior to billing Medicare.
- The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.
Key Coverage Criteria
- Non-invasive cerebrovascular arterial studies are covered when reasonable and necessary as defined by Novitas Local Coverage Determination (LCD) L35397.
- Duplex post-interventional follow-up studies (typically limited and unilateral) are covered for evaluation after cerebrovascular intervention.
- Vascular studies performed after carotid endarterectomy are covered when the claim includes the procedure date and the narrative 'carotid endarterectomy.'
- 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.
18 Active Policies
A56551 — Billing and Coding: Visual Fields Testing
J06
L33574 — Visual Fields Testing
J06
L33766 — Visual Field Examination
J09
A57637 — Billing and Coding: Visual Field Examination
J09
A57667 — Billing and Coding: Special EEG Tests
Related Codes
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