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CPT Code: 92082  Region: 24

States covered:  Kentucky, Ohio

Title:  Visual Field Examination - Intermediate Intensity

Category
Special Ophthalmological Services

Description
Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, least 2 isopters on Goldmann Perimeter, or semi-quantitative automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus Program 33)

FEE SCHEDULE



PROCEDURE DESCRIPTION

Visual field testing detects defects in the field of vision, testing the function of the retina, optic nerve and optic pathways.  Formal visual field tests are generally performed using automated perimetry, i.e., measurement of the ability to see points of light at varying locations on a curved surface.

CLINICAL INDICATIONS

Visual field examinations are considered medically necessary for the conditions listed below:

  • The patient has a disorder of the eyelid(s) potentially affecting the visual field(s)
  • The patient has a visual field defect detected on gross visual field testing (e.g., confrontational testing)
  • The patient has a documented diagnosis of glaucoma (It should be noted that the progression of, and effects of treatment on glaucoma can be monitored only through periodic visual field testing.  The frequency of such examinations is dependent on changes in intraocular pressure (IOP), retinal damage and changes at the optic disc.)
  • The patient is suspected of having glaucoma; signs include increased intraocular pressure, asymmetric IOP measurements, notching or thinning of the neuroretinal rim, splinter hemorrhages and asymmetric appearance of the discs
  • The patient has a documented disorder of the optic nerve, the retina or the neurologic visual pathway
  • The patient has a recent intracranial hemorrhage, an intracranial mass or a recent increased intracranial pressure measurement (with or without visual symptoms)
  • The patient has a recent occlusion / stenosis of cerebral or precerebral arteries
  • The patient has a history of a cerebral aneurysm, pituitary or occipital tumor potentially affecting the visual fields
  • The patient is being evaluated for buphthalmos, congenital anomalies of the posterior segment or congenital ptosis
  • The patient has a disorder of the orbit potentially affecting the visual field
  • The patient has sustained a significant eye injury
  • The patient has unexplained visual loss
  • The patient has a pale or swollen optic nerve on a recent examination
  • The patient is having new functional limitations which may be due to visual field loss (e.g., reports by family of patient bumping into objects) (change to e.g.,)
  • The patient is taking a medication with a high risk of affecting the visual system (e.g., Plaquenil)
  • The patient is being evaluated for macular degeneration, or has experienced central vision loss (< 20/70) (Repeated examinations for diagnosis of macular degeneration or central vision loss are not medically necessary unless changes in vision are documented, or to evaluate the results of a surgical intervention.)


Limitations:

Gross visual field testing (e.g., confrontation testing) is a part of general ophthalmological service and should not be reported separately.

COVERED DIAGNOSES

ICD-10 Diagnosis Codes



DOCUMENTATION REQUIREMENTS

The patient’s medical record must contain documentation that fully supports the medical necessity for services included within this LCD.  This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

CODING GUIDELINES

  • For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim
  • A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act
  • The diagnosis code(s) must best describe the patient’s condition for which the service was performed
  • All services are considered bilateral. Use modifier RT or LT only when one eye is being examined

Use 92082 when reporting the following alternate terminology:

  • Octopus program 33 or 34 or equivalent
  • Quantity defects strategy (missed points are threshold and depth of defect recorded)

If the claim contains a separate charge for gross visual fields, it will be denied as an incidental service.

Z13.9 (Encounter for screening, unspecified) should be use in the absence of any signs or symptoms to indicate screening.

Claims for visual fields testing services are payable under Medicare Part B in the following places of service:

The global services (technical plus professional) may be billed in the following places of service:

  • Office, nursing facility and independent clinic

The technical component may be billed in the following places of service:

  • Office, nursing facility, independent clinic, federally qualified health center and rural health clinic

The professional component may be billed at the following places of service:

  • Office, inpatient hospital, outpatient hospital, emergency room, skilled nursing facility, nursing facility, independent clinic and comprehensive outpatient rehabilitation facility

UTILIZATION GUIDELINES

This Medicare carrier has no specific utilization guidelines for visual field tests; however, keep in mind the frequency of testing is dictated by the stage of the disease or the degree of risk factors.  Please note that repeated examination for the diagnosis of macular degeneration or an experience of central vision loss are not necessary unless changes in vision are documented or to evaluate the results of surgical intervention.

In the absence of specific utilization guidelines, optometrists and ophthalmologists should adhere to CMS Ruling 95-1 (V) which states that utilization of these services should be consistent with locally acceptable standards of medical practice.

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