S04.019A — Injury of optic nerve, unspecified eye, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
- The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.
- Refer to NCCI and OPPS requirements prior to billing Medicare to ensure coding compliance and to determine any bundling or packaging edits.
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.
- Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
- Formal visual field testing is medically necessary for patients with a disorder of the eyelid(s) that may affect the visual field.
- Formal visual field testing is medically necessary when a visual field defect is detected on gross (confrontation) visual field testing.
10 Active Policies
L37015 — Visual Electrophysiology Testing
J05
A57599 — Billing and Coding: Visual Electrophysiology Testing
J05
L36831 — Visual Electrophysiology Testing
J06
A57060 — Billing and Coding: Visual Electrophysiology Testing
J06
A56551 — Billing and Coding: Visual Fields Testing
Related Codes
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