CPT Code: 76513  Region: 05

States covered:  Florida, Puerto Rico, Virgin Islands

Title:  Anterior Segment Ultrasound or High Resolution Biomicroscopy

Category
Ophthalmic Ultrasound

Description
Anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy



Ophthalmic ultrasounds involve the transmission of high-frequency sound waves through the eye and the measurement of their reflection from ocular structures.  An A-scan converts the resulting echoes into waveforms whose crests represent the position of different structures.  The B-scan converts the echoes into patterns of dots that form a two-dimensional, cross-sectional image of the ocular structure.

Ocular and orbital echography and sonography, jointly referred to as ultrasonography, are medically appropriate diagnostic tools to diagnose and/or follow ocular and orbital pathologies.

 

Identification and/or follow-up for the following:

  • Disorders of the globe
  • Retinal defects and detachments
  • Other retinal disorders
  • Disorders of the choroid
  • Disorders of the iris and ciliary body
  • Cataract
  • Corneal scars and opacities
  • Other corneal disorders
  • Disorders of the orbit
  • Disorders of the optic nerve
  • Other disorders of the eye
  • Disorders of the vitreous
  • Disorders of the lens
  • Congenital anomalies of corneal size and shape
  • Neoplasm of the eye
  • Injury to the eye
  • Systemic disease

ICD-10 Diagnosis Codes

ICD-10 CodeDescription
A18.51 Tuberculous episcleritis
A18.53 Tuberculous chorioretinitis
A18.59 Other tuberculosis of eye
C69.00 - C69.92 Malignant neoplasm of unspecified conjunctiva - Malignant neoplasm of unspecified site of left eye
C79.32 - C79.49 Secondary malignant neoplasm of cerebral meninges - Secondary malignant neoplasm of other parts of nervous system
D09.20 - D09.22 Carcinoma in situ of unspecified eye - Carcinoma in situ of left eye
D18.09 Hemangioma of other sites
D31.00 - D31.92 Benign neoplasm of unspecified conjunctiva - Benign neoplasm of unspecified part of left eye
D48.7 Neoplasm of uncertain behavior of other specified sites
D49.81 - D49.89 Neoplasm of unspecified behavior of retina and choroid - Neoplasm of unspecified behavior of other specified sites
D57.00 - D57.219 Hb-SS disease with crisis, unspecified - Sickle-cell/Hb-C disease with crisis, unspecified
D57.80 - D57.819 Other sickle-cell disorders without crisis - Other sickle-cell disorders with crisis, unspecified
E08.311 - E08.3599 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema - Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye
E08.37X1 - E08.37X9 Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye - Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, unspecified eye
E09.311 - E09.3599 Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema - Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
E09.37X1 - E09.37X9 Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye - Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye
E10.311 - E10.3599 Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema - Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
E11.311 - E11.3599 Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema - Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
E11.37X1 - E11.37X9 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye - Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye
E13.311 - E13.3599 Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema - Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
E13.37X1 - E13.37X9 Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, right eye - Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye
E85.1 - E85.9 Neuropathic heredofamilial amyloidosis - Amyloidosis, unspecified
G45.3 Amaurosis fugax
H05.00 - H05.049 Unspecified acute inflammation of orbit - Tenonitis of unspecified orbit
H05.10 - H05.129 Unspecified chronic inflammatory disorders of orbit - Orbital myositis, unspecified orbit
H05.20 - H05.269 Unspecified exophthalmos - Pulsating exophthalmos, unspecified eye
H05.50 - H05.53 Retained (old) foreign body following penetrating wound of unspecified orbit - Retained (old) foreign body following penetrating wound of bilateral orbits
H05.811 - H05.819 Cyst of right orbit - Cyst of unspecified orbit
H05.821 - H05.89 Myopathy of extraocular muscles, right orbit - Other disorders of orbit
H15.001 - H15.9 Unspecified scleritis, right eye - Unspecified disorder of sclera
H16.241 - H16.249 Ophthalmia nodosa, right eye - Ophthalmia nodosa, unspecified eye
H17.00 - H17.9 Adherent leukoma, unspecified eye - Unspecified corneal scar and opacity
H18.001 - H18.009 Unspecified corneal deposit, right eye - Unspecified corneal deposit, unspecified eye
H18.011 - H18.069 Anterior corneal pigmentations, right eye - Stromal corneal pigmentations, unspecified eye
H18.10 - H18.13 Bullous keratopathy, unspecified eye - Bullous keratopathy, bilateral
H18.20 - H18.239 Unspecified corneal edema - Secondary corneal edema, unspecified eye
H18.50 - H18.59 Unspecified hereditary corneal dystrophies - Other hereditary corneal dystrophies
H18.70 - H18.799 Unspecified corneal deformity - Other corneal deformities, unspecified eye
H21.00 - H21.359 Hyphema, unspecified eye - Exudative cyst of pars plana, unspecified eye
H21.40 - H21.43 Pupillary membranes, unspecified eye - Pupillary membranes, bilateral
H25.20 - H25.23 Age-related cataract, morgagnian type, unspecified eye - Age-related cataract, morgagnian type, bilateral
H25.89 Other age-related cataract
H26.101 - H26.139 Unspecified traumatic cataract, right eye - Total traumatic cataract, unspecified eye
H26.40 - H26.499 Unspecified secondary cataract - Other secondary cataract, unspecified eye
H27.10 - H27.139 Unspecified dislocation of lens - Posterior dislocation of lens, unspecified eye
H30.001 - H32 Unspecified focal chorioretinal inflammation, right eye - Chorioretinal disorders in diseases classified elsewhere
H33.001 - H33.8 Unspecified retinal detachment with retinal break, right eye - Other retinal detachments
H34.00 - H34.9 Transient retinal artery occlusion, unspecified eye - Unspecified retinal vascular occlusion
H35.00 - H35.09 Unspecified background retinopathy - Other intraretinal microvascular abnormalities
H35.171 - H35.469 Retrolental fibroplasia, right eye - Secondary vitreoretinal degeneration, unspecified eye
H35.50 - H35.739 Unspecified hereditary retinal dystrophy - Hemorrhagic detachment of retinal pigment epithelium, unspecified eye
H35.81 - H35.89 Retinal edema - Other specified retinal disorders
H36 Retinal disorders in diseases classified elsewhere
H43.00 - H43.9 Vitreous prolapse, unspecified eye - Unspecified disorder of vitreous body
H44.001 - H44.19 Unspecified purulent endophthalmitis, right eye - Other endophthalmitis
H44.50 - H44.9 Unspecified degenerated conditions of globe - Unspecified disorder of globe
H46.10 - H46.13 Retrobulbar neuritis, unspecified eye - Retrobulbar neuritis, bilateral
H47.021 - H47.029 Hemorrhage in optic nerve sheath, right eye - Hemorrhage in optic nerve sheath, unspecified eye
H47.10 - H47.149 Unspecified papilledema - Foster-Kennedy syndrome, unspecified eye
H47.20 - H47.299 Unspecified optic atrophy - Other optic atrophy, unspecified eye
H47.311 - H47.399 Coloboma of optic disc, right eye - Other disorders of optic disc, unspecified eye
H57.03 Miosis
H57.8 Other specified disorders of eye and adnexa
Q10.7 Congenital malformation of orbit
Q13.0 - Q13.9 Coloboma of iris - Congenital malformation of anterior segment of eye, unspecified
Q14.0 - Q14.9 Congenital malformation of vitreous humor - Congenital malformation of posterior segment of eye, unspecified
Q15.0 Congenital glaucoma
S05.10XA - S05.32XS Contusion of eyeball and orbital tissues, unspecified eye, initial encounter - Ocular laceration without prolapse or loss of intraocular tissue, left eye, sequela
S05.50XA - S05.92XS Penetrating wound with foreign body of unspecified eyeball, initial encounter - Unspecified injury of left eye and orbit, sequela
T15.00XA - T15.02XS Foreign body in cornea, unspecified eye, initial encounter - Foreign body in cornea, left eye, sequela
T85.22XA - T85.22XS Displacement of intraocular lens, initial encounter - Displacement of intraocular lens, sequela
T85.318A - T85.318S Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, initial encounter - Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, sequela
T85.328A - T85.328S Displacement of other ocular prosthetic devices, implants and grafts, initial encounter - Displacement of other ocular prosthetic devices, implants and grafts, sequela
T85.398A - T85.398S Other mechanical complication of other ocular prosthetic devices, implants and grafts, initial encounter - Other mechanical complication of other ocular prosthetic devices, implants and grafts, sequela
T86.840 - T86.849 Corneal transplant rejection - Unspecified complication of corneal transplant


Medical record documentation maintained by the ordering/referring physician must indicate the medical necessity for performing the test and the test results.  This information is usually found in the history and physical, office/progress notes, or test results.

If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s order for the studies.  The physician must state the clinical indication/medical necessity for the study in his order for the test.

 

Report a High Resolution Biomicroscopy procedure with CPT code 76513.

B-scan implies a two-dimensional ultrasonic scanning procedure with two-dimensional display.

A B-scan is done for the purpose of evaluating the interior of the eye.  Medicare payment will be allowed only for services which are medially reasonable and necessary for the patient’s condition.

It is expected that these services would be performed as indicated by current medical literature and/or standards of practice.  When services are performed in excess of established parameters, they may be subject to review for medical necessity.