Z03.6 — Encounter for observation for suspected toxic effect from ingested substance ruled out
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
- Include relevant medical history in the medical record that supports the need for the visual field test.
- The medical record must include the ordering provider’s assessment related to the patient’s complaint for the visit when visual field testing is ordered.
- Include results of pertinent tests and procedures in the medical record; for diagnostic tests, include the test result if known or the symptom prompting the test.
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.
- SCODI (CPT 92133, 92134) is considered medically reasonable and necessary for evaluation of retinal disorders, glaucoma, and anterior segment disorders as documented in LCD L34760.
- CT thorax is covered for diagnosis and/or staging of neoplastic and hematologic processes arising in or involving the thorax.
- CT thorax is covered to evaluate pulmonary, mediastinal, pleural, and chest wall infections and their complications.
6 Active Policies
A56916 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J05
L34760 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J05
A56580 — Billing and Coding: Computerized Axial Tomography (CT), Thorax
A56799 — Billing and Coding: Visual Fields Testing
L34394 — Visual Fields Testing
Related Codes
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