T76.91XA — Unspecified adult maltreatment, suspected, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Document general ophthalmoscopy and biomicroscopy findings in the medical record even when these services are included in extended ophthalmoscopy and not separately billed.
- For extended ophthalmoscopy, include a drawing or equivalent documentation that demonstrates the extended nature of the exam to support separate payment.
- Orders for CPT 92227 and CPT 92228 must be from the treating physician or other treating practitioner acting within the scope of license and Medicare requirements and this order must be documented in the record.
- When extended ophthalmoscopy is performed during a global surgery period and is unrelated to the surgical condition, document the unrelatedness and report modifier -76 or -79 as appropriate.
Key Coverage Criteria
- Extended ophthalmoscopy (CPT 92201, 92202) is payable when documented as an extended ophthalmoscopy that meets indicated standards (e.g., includes a retinal drawing or equivalent documentation) beyond a general ophthalmologic exam.
- Fundus photography (CPT 92227, CPT 92228) is covered when ordered by the treating physician or other treating practitioner acting within the scope of his/her license and Medicare requirements.
- CPT 92227 is covered when used to evaluate asymptomatic patients at risk with known disease likely to cause retinal disease (e.g., diabetes mellitus) when ordered by the treating physician.
- CPT 92228 is a covered service when ordered by the treating physician or other treating practitioner acting within the scope of license and Medicare requirements.
- CPT codes 96132, 96133, 96136, 96137, 96138, and 96139 may be used for neuropsychological testing intended to diagnose or characterize neurocognitive effects of medical disorders that impinge directly or indirectly on the brain.
- Neuropsychological testing is covered when testing is necessary as an aid in diagnosis and therapeutic planning and the medical record documents the necessity.
4 Active Policies
A57780 — Billing and Coding: Psychological and Neuropsychological Tests
J09
L34520 — Psychological and Neuropsychological Tests
J09
A53060 — Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
L33467 — Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Related Codes
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