Print | ShareCPT Code: 92025 Region: 05
States covered: Florida, Puerto Rico, Virgin Islands
Title: Computerized Corneal Topography
Category
Special Ophthalmological Services
Description
Computerized corneal topography, unilateral or bilateral, with interpretation and report
Computerized Corneal Topography (also known as computer-assisted video keratography (CAVK) and corneal mapping is a computer assisted diagnostic imaging technique in which a special instrument projects a series of light rings on the cornea, creating a color coded map of the corneal surface as well as a cross-section profile. This service is used to provide a detailed map or chart of the physical features and shape of the anterior surface of the cornea. This permits a more accurate portrayal of the physical state of the cornea and the subtle detection of corneal surface irregularity and astigmatism.
Medicare will consider Computerized Corneal Topography medically necessary under any of the following conditions:
- Pre-operatively for evaluation of irregular astigmatism prior to cataract surgery
- Monocular diplopia
- Bullous keratopathy
- Post surgical or post traumatic astigmatism, measuring at a minimum of 3.5 diopters
- Post penetrating keratoplasty surgery
- Post surgical or post traumatic irregular astigmatism
- Corneal dystrophy
- Complications of transplanted cornea
- Post traumatic corneal scarring
- Keratoconus; and/or
- Pterygium and/or corneal ectasia that cause visual impairment.
Limitations
- Corneal topography will only be allowed for a pre-operative cataract patient if documentation supports that the patient has irregular astigmatism
- Corneal topography is to be billed only when the diagnosis of monocular diplopia is thought to be caused by a corneal irregularity
- Corneal topography is a covered service for the above indications when medically reasonable and necessary only if the results will assist in defining further treatment — it is not covered for routine follow-up testing
- Repeat testing is only indicated if a change of vision is reported in connection with one of the above listed conditions
- Services performed for screening purposes or in the absence of associated signs, symptoms, illness or injury as indicated above, will be denied as non-covered
- Corneal topography will be non-covered if performed pre- or post-operatively in relation to a Medicare non-covered procedure, i.e., radial keratotomy
ICD-10 Diagnosis Codes
Medical Necessity ICD-10 Codes Asterisk Explanation
**ICD-10-CM codes H52.211-H52.229 must be accompanied by diagnosis code Z98.41-Z98.49 or Z98.83.
*Diagnosis codes Z94.7, Z98.41-Z98.49, and Z98.83 should not be billed as the primary diagnosis.
Medical record documentation submitted by the ordering/referring eye doctor must indicate the medical necessity for performing the procedure and the results derived from the corneal topography procedure. This information is usually found in the history and physical, office/progress notes and the computerized corneal topography imaging interpretation and report.
1. Report Computerized Corneal Topography with CPT Code 92025. This is a bilateral test, therefore no modifiers are required if both eyes are examined. A unit of “1” is placed in the unit field of the CMS 1500 form or its electronic equivalent.
2. This Medicare carrier believes that regular astigmatism and irregular astigmatism not associated with post-operative eye surgery status or post-trauma is a refractive issue, the evaluation of which is not a Medicare benefit.
3. Services performed for screening purposes or lacking documentation of signs, symptoms, illness or injuries will not be covered.
4. Corneal topography will not be a covered service if it is performed pre-operatively or post-operatively for non-covered Medicare procedures such as radial or refractive keratoplasty.
5. An eye examination may be reported on the same day as corneal topography if it is medically necessary.
6. Corneal topography requires general supervision by the optometrist/ophthalmologist.
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.