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CPT Code: 92132  Region: 37

States covered:  General guidelines if your state does not have a local coverage determination

Title:  Scanning Laser - Anterior Segment

Category
Special Ophthalmological Services

Description
Scanning computerized ophthalmic diagnostic imaging, anterior segment, unilateral or bilateral

DISCLAIMER

This Medicare carrier does not have a local coverage determination (LCD) for scanning computerized ophthalmic diagnostic imaging, anterior segment.  The policy is a sample and is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.  

FEE SCHEDULE



PROCEDURE DESCRIPTION

In optical coherence tomography (OCT), low coherence near-infrared light is split into a probe and a reference beam. The probe beam is directed at the tissues while the reference beam is sent to a moving reference mirror.  The probe light beam is reflected from tissues according to their distance, thickness, and refractive index, and is then combined with the beam reflected from the moving reference mirror.  When the path lengths of the two light beams coincide (known as constructive interference), this provides a measure of the depth and reflectivity of the tissue that is analogous to an ultrasound A scan at a single point.  A computer then corrects for axial eye movement artifacts and constructs a 2-dimensional B mode image from successive longitudinal scans in the transverse direction.  A map of the tissue is then generated based on the different reflective properties of its components, resulting in a real-time cross-sectional histological view of the tissue.

Optical coherence tomography is a method used in evaluating the anterior segment of the eye (e.g., the cornea, iris, anterior chamber and the central portion of the lens).  Primary angle closure glaucoma is a common cause of visual loss.  Currently, gonioscopy is the standard method for evaluating the anatomy of the anterior segment of the eye.  Anterior segment OCT (AS-OCT), with its rapid, non-contact, and high-resolution image acquisition, is a decision-making tool for the assessment of the anterior chamber angle (ACA) configuration, including changes induced by illumination and laser peripheral iridotomy.  It has the potential for use as a rapid screening tool for detection of occludable angles.

CLINICAL INDICATIONS

SCODI may be used to examine the structures in the anterior segment structures of the eye.  However, it is still seen as experimental/investigational except in the following:

  • Narrow angle, suspected narrow angle, and mixed narrow and open angle glaucoma
  • Determining the proper intraocular lens for a patient who has had prior refractive surgery and now requires cataract extraction
  • Iris tumor
  • Presence of corneal edema or opacity that precludes visualization or study of the anterior chamber
  • Calculation of lens power for cataract patients who have undergone prior refractive surgery.  Payment will only be made for the cataract codes as long as additional documentation is available in the patient record of their prior refractive procedure.  Payment will not be made in addition to A-scan or IOL master.
  • Certain exceptions that must be determined on a case-by-case basis with the appropriate documentation.

COVERED DIAGNOSES

ICD-10 Diagnosis Codes



DOCUMENTATION REQUIREMENTS

1.  All documentation should be maintained in the patient’s medical record and made available to the contractor upon request.

2.  Every page of the record should be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)).  The documentation should include the legible signature of the optometrist/ophthalmologist responsible for and providing the care to the patient.

3.  The submitted medical record should support the use of the selected ICD-10-CM code(s).  The submitted CPT/HCPCS code should describe the service performed.

4.  Medical record documentation (e.g., office/progress notes) maintained by the performing physician should indicate the medical necessity of the scanning computerized ophthalmic diagnostic imaging.  Additionally, a copy of the test results, computer analysis of the data, and appropriate data storage for future comparison in follow-up exams should be maintained in the patient’s file.

5.  If bilateral studies are reported, the documentation maintained by the provider should demonstrate medical need for the performance of the test for each eye.

6.  When reporting ICD-10 codes(s) Z79.891, Z79.899, Z09 or Z03.6, Z03.89, the medical record should reflect the medication administered as well as the underlying condition for which it was given.

CODING GUIDELINES

1.  Report a Scanning Computerized Ophthalmic Diagnostic Imaging, Anterior Segment test with CPT code 92132.  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.  Scanning Computerized Ophthalmic Diagnostic Imaging Anterior test requires general supervision by the optometrist/ophthalmologist.

3.  An eye examination may be reported on the same day with Scanning Computerized Ophthalmic Diagnostic Imaging Anterior test if it is medically necessary.

4.  Scanning Computerized Ophthalmic Diagnostic Imaging Anterior Segment, cannot be coded for if an A-Scan is already performed to determine intraocular lens calculation.  The eye doctor may choose which test is appropriate for the patient, but only one can be billed.

5. Scanning Computerized Ophthalmic Diagnostic Imaging Anterior Segment (92132) may be billed on the same day as Scanning Computerized Ophthalmic Diagnostic Imaging Posterior Segment (optic nerve) (92133) and Scanning Computerized Ophthalmic Diagnostic Imaging Posterior Segment (retina) (92134).

UTILIZATION GUIDELINES

This Medicare carrier has no specific utilization guidelines for a scanning laser of the anterior segment.  In the absence of specific utilization guidelines, optometrists/ophthalmologists should adhere to CMS Ruling 95-1 (V) which states that utilization of these services should be consistent with locally acceptable standards of practice.

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