S00.10XA — Contusion of unspecified eyelid and periocular area, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- List the appropriate CPT code for the procedure and include any applicable modifiers; adhere to Medicare global surgery and CCI (correct coding initiative) rules for eyelid surgeries.
- Submit physicians' services and diagnostic tests with a diagnosis code that supports medical necessity and code to the greatest level of specificity (full digit completeness).
- Use the diagnosis code based on diagnostic test results as the primary diagnosis; if test results are normal or inconclusive, use the diagnosis code for the sign or symptom that prompted the test as the primary diagnosis.
- When signs or symptoms are present, place the appropriate definitive diagnosis code in the first position and an available symptom diagnosis code in the second position on CMS-1500 item 21 (or electronic equivalent).
Key Coverage Criteria
- Blepharoplasty, blepharoptosis repair, or brow lift is covered when documented signs or symptoms of a functional abnormality of the upper eyelids are present as defined by the associated LCD (L34528).
- 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.
4 Active Policies
A56908 — Billing and Coding: Blepharoplasty, Blepharoptosis and Brow Lift
J05
L34528 — Blepharoplasty, Blepharoptosis and Brow Lift
J05
A57637 — Billing and Coding: Visual Field Examination
J09
L33766 — Visual Field Examination
J09
Related Codes
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