Z98.42 — Cataract extraction status, left eye
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- Medical record documentation by the ordering/referring physician must state the clinical indication/medical necessity for the test and include the test results.
- If the performing provider is different from the ordering/referring physician, the performing provider must maintain hard copy test results and interpretation plus copies of the ordering/referring physician's order.
- Documentation should contain a history and physical (H&P) supporting the diagnosis for which the corneal pachymetry is being rendered.
Key Coverage Criteria
- Corneal pachymetry (measurement of corneal thickness) is covered to evaluate patients with a diagnosis of increased intraocular pressure.
- Repeat corneal pachymetry is covered after interval corneal trauma or corneal surgery to reassess corneal thickness.
- Corneal pachymetry is generally covered when performed as indicated by current medical literature or accepted standards of practice for clinical management.
- Computerized corneal topography is billable when performed as a diagnostic test for corneal conditions and the claim includes a diagnosis code that best describes the patient's condition for which the service was performed.
- Corneal pachymetry is medically necessary to determine the amount of endothelial trauma sustained during intraocular surgery.
- Corneal pachymetry is medically necessary for preoperative assessment of corneal health in patients with Fuchs dystrophy.
5 Active Policies
A56548 — Billing and Coding: Corneal Pachymetry
J06
L33630 — Corneal Pachymetry
J06
CIGNA-0125 — Intraocular Lens Implant - (0125)
A56816 — Billing and Coding: Computerized Corneal Topography
L34008 — Computerized Corneal Topography
Related Codes
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