Print | ShareCPT Code: 92286 Region: 37
States covered: General guidelines if your state does not have a local coverage determination
Title: Specular Endothelial Microscopy
Category
Special Ophthalmological Services
Description
The specular microscope is a special instrument that allows the doctor and photographer to see and record the corneal endothelial cells.
This Medicare carrier does not have a local coverage determination (LCD) for specular endothelial microscopy. The policy presented is provided to serve as a sample for how other carriers allow the procedure to be billed and coded. It is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.
The specular microscope is a special instrument that allows the doctor and photographer to see and record the corneal endothelial cells. Some instruments touch the front or the cornea. Others are non-contact. These instruments take advantage of a bright specular or mirror like image that is created when the angle of the light for photography is at the correct angle. Since the cornea is clear, only a small amount returns to do the photography.
1. Identification and/or follow-up for disorders of endothelial cell function
- Assessment of corneal edema
- Assessment of endothelial corneal dystrophy
2. Identification and/or follow-up for disorders of the iris and ciliary body
- Iridocyclitis
- Glaucomatocyclitic crises
- Pigmentary iris degeneration
3. Identification and/or follow-up for cataract
- Traumatic cataract
- Cataract in inflammatory ocular disorders
- Cataract with ocular neovascularization
4. Identification and/or follow-up for other disorders of the lens
- Aphakia
- Subluxation of lens
- Anterior dislocation of lens
5. Pre-operative assessment for high-risk ocular surgery
- Patients about to undergo a cataract extraction following a corneal transplant
- Patients about to undergo a cataract extraction following previous intraocular surgery
- Patients about to undergo a secondary lens implantation
- Patients about to undertgo a second intraocular surgery on the same eye
6. Post-operative management of ocular sugery
- Pseudo-aphakia
- Mechanical complication of corneal graft
- Cataract fragments in the eye following cataract surgery
- Overnight contact lens wear following cataract surgery
7. Diagnosis and treatment of injury to the eye
- Alkaline chemical burn of the cornea and conjunctival sac
- Acid chemical burn of the cornea and conjunctival sac
- Other burn of the cornea and conjunctival sac
ICD-10 Diagnosis Codes
| ICD-10 Code | Description |
|---|---|
| H18.10 - H18.13 | Bullous keratopathy, unspecified eye - Bullous keratopathy, bilateral |
| H18.20 | Unspecified corneal edema |
| H18.221 - H18.239 | Idiopathic corneal edema, right eye - Secondary corneal edema, unspecified eye |
| H18.51 | Endothelial corneal dystrophy |
| H18.59 | Other hereditary corneal dystrophies |
| H27.00 - H27.03 | Aphakia, unspecified eye - Aphakia, bilateral |
| Q12.3 | Congenital aphakia |
| Z96.1 | Presence of intraocular lens |
1. The medical record should clearly indicate the condition being evaluated and the primary diagnosis should support the medical necessity of the specular endothelial microscopy.
2. The documentation should be legible and should be made available to Medicare upon request.
3. The results of the specular endothelial microscopy test should be maintained for any potential post-payment audit.
1. Report specular endothelial microscopy with CPT code 92286. This is a bilateral service on the Medicare Physician Fee Schedule database. The procedure should be reported on a single service line without the -50, -RT or -LT modifiers. A unit of “1” is placed in the unit field of the CMS 1500 form or its electronic equivalent.
2. If only one eye is photographed, the -52 modifier may be appended to the service line. A unit of “1” is placed in the unit field of the CMS 1500 form or its electronic equivalent.
- If the payor does not require the specific reporting of unilateral services, then it is up to the doctor to decide how to report services (i.e., with or without the -52 modifier)
3. Specular endothelial microscopy requires general supervision by the optometrist/ophthalmologist.
4. It may be necessary to take a series of photographs at one session to document the patient’s progress. However, CPT code 92286 should only be reported once for a series of photographs taken at one session.
5. An eye examination may be reported on the same day as specular endothelial microscopy and if it is medically necessary.
1. The results of the test should have specific relevance to the individual patient and be utilized in the management of the patient’s ocular disease.
2. It is generally not medically necessary to perform corneal pachymetry and specular endothelial microscopy on the same day. Combinations of such services may be denied unless the need for each test is documented.
3. A National Coverage Determination precludes separate coverage of specular endothelial microscopy in patients undergoing cataract surgery in whom there are no visual problems related to known corneal conditions. Therefore, specular endothelial microscopy is not medically necessary if it is performed as part of a preoperative examination for cataract surgery when the only visual problem is cataracts.