* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download PG0037 Corneal Pachymetry
Survey
Document related concepts
Vision therapy wikipedia , lookup
Visual impairment wikipedia , lookup
Mitochondrial optic neuropathies wikipedia , lookup
Blast-related ocular trauma wikipedia , lookup
Diabetic retinopathy wikipedia , lookup
Eyeglass prescription wikipedia , lookup
Near-sightedness wikipedia , lookup
Cataract surgery wikipedia , lookup
Visual impairment due to intracranial pressure wikipedia , lookup
Contact lens wikipedia , lookup
Transcript
POLICY . . . . . . . . PG-0037 EFFECTIVE . . . . . .09/15/04 LAST REVIEW . . . 10/08/13 MEDICAL POLICY Corneal Pachymetry GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder contract. Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy and adherence to accepted national standards. This guideline is solely for explaining correct procedure reporting and does not imply coverage and reimbursement. DESCRIPTION Corneal pachymetry is a non-invasive ultrasonic technique for measuring corneal thickness. It is primarily used to assist with the diagnosis, assessment, and/or monitoring of corneal diseases and to assess suspected or established glaucoma. POLICY Corneal pachymetry does not require prior authorization Corneal pachymetry is covered when the test is integral to the medical management decision-making of the patient; and Corneal pachymetry is covered for the patient who has one of the following conditions: Corneal ectasias, e.g., keratoglobus, pellucid degeneration, and keratoconus Fuch’s endothelial dystrophy or bullous keratopathy Posterior polymorphous dystrophy Corneal rejection post-penetrating keratoplasty Corneal edema Elevated intraocular pressure in glaucoma suspect when corneal thickness is unknown Worsening of glaucoma when corneal thickness is unknown Enlarged cup-disc ratio is equal to or greater than 0.3 Corneal pachymetry is covered preoperatively for patients scheduled for corneal transplant. Corneal pachymetry is covered postoperatively when the test is performed following corneal transplant. Corneal pachymetry is not covered to evaluate refractive errors. HMO, PPO, Individual Marketplace, Elite, Advantage This is considered a covered service for all members. This service cannot be submitted with modifier –50, as it represents a bilateral service within its CPT descriptor. It will be denied if submitted with this modifier. If the procedure is only performed on a single side, the service should be reported with modifier –52, and reimbursement will be allowed at 50% of the fee schedule. Corneal pachymetry will be allowed once per lifetime for the evaluation of the patient who meets the indications of coverage. The medical record should reflect the medical necessity for the performance of the pachymetry service, as well as the results, medical management, indications and determinations. CODING/BILLING INFORMATION The appearance of a code in this section does not necessarily indicate coverage. Codes that are covered may have selection criteria that must be met. Payment for supplies may be included in payment for other services rendered. CPT CODES 76514 Corneal pachymetry, unilateral or bilateral (determination of corneal thickness) ICD-9-CM CODES 364.22 Glaucomatocyclitic crises 364.77 Recession of chamber angle of eye 365.00-365.9 371.00 371.10 371.11 371.12 371.13 371.14 371.15 371.16 371.20 371.21 371.22 371.23 371.50 371.57 371.58 371.60 371.61 371.62 Glaucoma Corneal opacity, unspecified Corneal deposit, unspecified Anterior corneal pigmentations Stromal corneal pigmentations Posterior corneal pigmentations Kayser-Fleischer ring Other corneal deposits associated with metabolic disorders Argentous corneal deposits Corneal edema, unspecified Idiopathic corneal edema Secondary corneal edema Bullous keratopathy Hereditary corneal dystrophy, unspecified Endothelial corneal dystrophy Other posterior corneal dystrophies Keratoconus, unspecified Keratoconus, stable condition Keratoconus, acute hydrops 371.70 Corneal deformity, unspecified 371.71 377.14 743.10-743.12 743.20-743.22 743.41-743.49 996.51 996.89 V45.61 V45.69 Corneal ectasia Glaucomatous atrophy [cupping] of optic disc Microphthalmos, unspecified – Microphthalmos associated with other anomalies of eye and adnexa Buphthalmos, unspecified - Buphthalmos associated with other ocular anomalies Congenital anomalies of corneal size and shape - Other congenital anomalies of anterior segment Mechanical complication due to corneal graft Complications of other specified transplanted organ Cataract extraction status Other states following surgery of eye and adnexa ICD-10-CM CODES; EFFECTIVE 10/01/2015 H17.89 H17.9 H18.001 H18.002 H18.003 H18.009 H18.011 H18.012 H18.013 H18.019 H18.021 H18.022 H18.023 H18.029 H18.031 H18.032 H18.033 H18.039 H18.041 H18.042 H18.043 H18.049 H18.051 Other corneal scars and opacities Unspecified corneal scar and opacity Unspecified corneal deposit, right eye Unspecified corneal deposit, left eye Unspecified corneal deposit, bilateral Unspecified corneal deposit, unspecified eye Anterior corneal pigmentations, right eye Anterior corneal pigmentations, left eye Anterior corneal pigmentations, bilateral Anterior corneal pigmentations, unspecified eye Argentous corneal deposits, right eye Argentous corneal deposits, left eye Argentous corneal deposits, bilateral Argentous corneal deposits, unspecified eye Corneal deposits in metabolic disorders, right eye Corneal deposits in metabolic disorders, left eye Corneal deposits in metabolic disorders, bilateral Corneal deposits in metabolic disorders, unspecified eye Kayser-Fleischer ring, right eye Kayser-Fleischer ring, left eye Kayser-Fleischer ring, bilateral Kayser-Fleischer ring, unspecified eye Posterior corneal pigmentations, right eye H18.052 H18.053 H18.059 H18.061 H18.062 H18.063 H18.069 H18.10 H18.11 H18.12 H18.13 H18.20 H18.221 H18.222 H18.223 H18.229 H18.231 H18.232 H18.233 H18.239 H18.50 H18.51 H18.59 H18.601 H18.602 H18.603 H18.609 H18.611 H18.612 H18.613 H18.619 H18.621 H18.622 H18.623 H18.629 H18.70 H18.711 H18.712 H18.713 H18.719 H18.791 H18.792 H18.793 H18.799 H21.551 H21.552 H21.553 H21.559 H40.001- H42 H47.231 H47.232 H47.233 H47.239 Q11.2 Posterior corneal pigmentations, left eye Posterior corneal pigmentations, bilateral Posterior corneal pigmentations, unspecified eye Stromal corneal pigmentations, right eye Stromal corneal pigmentations, left eye Stromal corneal pigmentations, bilateral Stromal corneal pigmentations, unspecified eye Bullous keratopathy, unspecified eye Bullous keratopathy, right eye Bullous keratopathy, left eye Bullous keratopathy, bilateral Unspecified corneal edema Idiopathic corneal edema, right eye Idiopathic corneal edema, left eye Idiopathic corneal edema, bilateral Idiopathic corneal edema, unspecified eye Secondary corneal edema, right eye Secondary corneal edema, left eye Secondary corneal edema, bilateral Secondary corneal edema, unspecified eye Unspecified hereditary corneal dystrophies Endothelial corneal dystrophy Other hereditary corneal dystrophies Keratoconus, unspecified, right eye Keratoconus, unspecified, left eye Keratoconus, unspecified, bilateral Keratoconus, unspecified, unspecified eye Keratoconus, stable, right eye Keratoconus, stable, left eye Keratoconus, stable, bilateral Keratoconus, stable, unspecified eye Keratoconus, unstable, right eye Keratoconus, unstable, left eye Keratoconus, unstable, bilateral Keratoconus, unstable, unspecified eye Unspecified corneal deformity Corneal ectasia, right eye Corneal ectasia, left eye Corneal ectasia, bilateral Corneal ectasia, unspecified eye Other corneal deformities, right eye Other corneal deformities, left eye Other corneal deformities, bilateral Other corneal deformities, unspecified eye Recession of chamber angle, right eye Recession of chamber angle, left eye Recession of chamber angle, bilateral Recession of chamber angle, unspecified eye Glaucoma Glaucomatous optic atrophy, right eye Glaucomatous optic atrophy, left eye Glaucomatous optic atrophy, bilateral Glaucomatous optic atrophy, unspecified eye Microphthalmos Q13.0 Q13.1 Q13.2 Q13.3 Q13.4 Q13.5 Q13.81 Q13.89 Q13.9 Q15.0 T85.318A T85.318D T85.318S T85.328A T85.328D T85.328S T85.398A T85.398D T85.398S T86.830 T86.831 T86.832 T86.838 T86.839 T86.840 T86.841 T86.890 T86.891 T86.892 T86.898 T86.899 Z98.41 Z98.42 Z98.49 Z98.83 Coloboma of iris Absence of iris Other congenital malformations of iris Congenital corneal opacity Other congenital corneal malformations Blue sclera Rieger's anomaly Other congenital malformations of anterior segment of eye Congenital malformation of anterior segment of eye, unspecified Congenital glaucoma Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, initial encounter Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, subsequent encounter Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, sequela Displacement of other ocular prosthetic devices, implants and grafts, initial encounter Displacement of other ocular prosthetic devices, implants and grafts, subsequent encounter Displacement of other ocular prosthetic devices, implants and grafts, sequela Other mechanical complication of other ocular prosthetic devices, implants and grafts, initial encounter Other mechanical complication of other ocular prosthetic devices, implants and grafts, subsequent encounter Other mechanical complication of other ocular prosthetic devices, implants and grafts, sequela Bone graft rejection Bone graft failure Bone graft infection Other complications of bone graft Unspecified complication of bone graft Corneal transplant rejection Corneal transplant failure Other transplanted tissue rejection Other transplanted tissue failure Other transplanted tissue infection Other complications of other transplanted tissue Unspecified complication of other transplanted tissue Cataract extraction status, right eye Cataract extraction status, left eye Cataract extraction status, unspecified eye Filtering (vitreous) bleb after glaucoma surgery status REVISION HISTORY EXPLANATION 01/01/06: No changes 08/01/07: Removed diagnosis editing 08/01/08: Updated references 08/15/09: No changes 01/01/11: No changes 10/08/13: Changes made per Medicare guidelines. Deleted codes 364.53, 366.11, & 996.80. Added codes 364.22, 371.00-371.16, 371.70, 377.14, 743.10-743.12, 743.20-743.22, 743.41-743.49, 996.89, V45.61, & V45.69. ICD-10 Codes added from ICD-9 conversion. Policy reviewed and updated to reflect most current clinical evidence. Approved by Medical Policy Steering Committee as revised. REFERENCES/RESOURCES Centers for Medicare and Medicaid Services, CMS Manual System and other CMS publications and services Ohio Department of Medicaid http://jfs.ohio.gov/ American Medical Association, Current Procedural Terminology (CPT ) and associated publications and services Industry Standard Review ®