S04.049D — Injury of visual cortex, unspecified side, subsequent encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
- The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- 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
- Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
- 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.
6 Active Policies
A56537 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J06
A56551 — Billing and Coding: Visual Fields Testing
J06
L34380 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J06
L33574 — Visual Fields Testing
J06
A57637
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.