S04.039D — Injury of optic tract and pathways, unspecified side, subsequent 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 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.
- Visual field testing is medically necessary for patients with a documented diagnosis of glaucoma for baseline, monitoring progression, and assessing treatment effects.
- Visual field testing is medically necessary when glaucoma is suspected, defined by signs such as increased intraocular pressure, asymmetric IOP measurements, neuroretinal rim notching or thinning, splinter hemorrhages, or asymmetric optic discs.
- Visual field testing is medically necessary for patients with a documented disorder of the optic nerve, the retina, or the neurologic visual pathway.
8 Active Policies
L37015 — Visual Electrophysiology Testing
J05
A57599 — Billing and Coding: Visual Electrophysiology Testing
J05
L36831 — Visual Electrophysiology Testing
J06
A56551 — Billing and Coding: Visual Fields Testing
J06
A57060 — Billing and Coding: Visual Electrophysiology Testing
Related Codes
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