Z12.89 — Encounter for screening for malignant neoplasm of other sites
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Extended ophthalmoscopy includes a detailed retinal drawing (disc, macula or periphery) accompanied by an interpretation and plan
- The drawing should be anatomically specific to the patient and clearly labeled
- The drawing should be of sufficient size, usually no less than 2.5 inches in diameter
- Documentation should support medical necessity (i.e., that the extended ophthalmoscopy will provide additive, non-duplicative information that will affect management)
Key Coverage Criteria
- Blunt injury to the eye or periorbital structures
- Chorioretinitis, chorioretinal scars or choroidal degeneration, dystrophies, hemorrhage and rupture, or detachment
- Degenerative disorders of the globe
- Diabetic retinopathy (i.e., background retinopathy or proliferative retinopathy retinal vascular occlusion, or separation of the retinal layers)
- Disorders of the vitreous body (i.e., vitreous hemorrhage or posterior vitreous detachment)
- High axial length myopia (-6.00 Diopters or less [toward -10.00 D])
4 Active Policies
AETNA-CPB-0352 — Tumor Markers
AETNA-CPB-0738 — Upper Gastrointestinal Endoscopy and Gastrointestinal Biopsy
AETNA-CPB-0767 — Extended Ophthalmoscopy
AETNA-CPB-0783 — In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions
Related Codes
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