CPT Code: 92133 Region: 02
States covered: Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, Wisconsin
Title: Scanning Laser - Posterior Segment (Optic Nerve)
Category
Special Ophthalmological Services
Description
Scanning computerized ophthalmic diagnostic imaging, posterior segment - optic nerve, unilateral or bilateral
State City/County Participating Provider Fee
Connecticut
All counties
41.23
Illinois
East St. Louis / Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, Randolph, St. Clair and Washington
37.15
Illinois
Suburban Chicago / Dupage, Kane, Lake and Will
39.89
Illinois
Chicago / Cook
39.74
Illinois
All other counties
36.23
Maine
Southern Maine / Cumberland and York
37.96
Maine
All other counties
35.96
Massachusetts
Metropolitan Boston / Middlesex, Norfolk and Suffolk
42.21
Massachusetts
All other counties
39.74
Minnesota
All counties
37.94
New Hampshire
All counties
39.21
New York
Manhattan / New York
43.28
New York
New York City suburbs, Long Island / Bronx, Kings, Nassau, Richmond, Rockland, Suffolk and Westchester
44.28
New York
Poughkpsie, North New York City suburbs / Columbia, Delaware, Dutchess, Greene, Orange, Putnam, Sullivan and Ulster
40.17
New York
Queens
44.21
New York
All other counties
36.62
Rhode Island
All counties
39.51
Vermont
All counties
38.01
Wisconsin
All counties
36.64
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) is a non-invasive, non-contact imaging technique. SCODI produces high resolution, cross-sectional tomographic images of ocular structures and is used for the evaluation of anterior segment and posterior segment disease.
Posterior segment SCODI allows for earlier detection of optic nerve and retinal nerve fiber layer pathologic changes before there is visual field loss. When appropriately used in the management of the glaucoma patient or glaucoma suspect, therapy can be initiated before there is irreversible loss of vision. This imaging technology provides the capability to discriminate among patients with normal intraocular pressures who have glaucoma, patients with elevated intraocular pressure who have glaucoma, and patients with elevated intraocular pressure who do not have glaucoma. SCODI also permits high resolution assessment of the retinal and choroidal layers, the presence of thickening associated with retinal edema, and of macular thickness measurement. Vitreo-retinal and vitreo-papillary relationships are displayed permitting surgical planning and assessment.
Posterior Segment optical coherence tomography (OCT) is considered to be reasonable and necessary to:
- Diagnose and manage medically and surgically retinal and neuro-ophthalmic diseases which involve changes in the optic nerve, subretinal and intraretinal changes, vitreo-retinal relationships and changes in the nerve fiber layer.
- Diagnose early glaucoma and monitor glaucoma treatment
- Differentiate causes of other optic nerve disorders when a diagnosis is in doubt.
- Diagnose and manage the patient’s condition when visual field results are insufficient; or when reliable visual field testing cannot be performed, due to visual, physical, mental, or age constraints.
- Differentiate when a discrepancy exists between the clinical appearance of the optic nerve and the visual fields
- Detect further loss of optic nerve or retinal nerve fiber layer changes in the presence of advanced optic nerve damage and advanced visual field loss
- Follow glaucoma suspects
LIMITATIONS OF COVERAGE:
- Absence of an indication
- Screening
ICD-10 Diagnosis Codes
ICD-10 Codes | Description |
---|---|
C69.81 | Malignant neoplasm of overlapping sites of right eye and adnexa |
C69.82 | Malignant neoplasm of overlapping sites of left eye and adnexa |
C70.0 | Malignant neoplasm of cerebral meninges |
C70.9 | Malignant neoplasm of meninges, unspecified |
C71.0 | Malignant neoplasm of cerebrum, except lobes and ventricles |
C71.1 | Malignant neoplasm of frontal lobe |
C71.2 | Malignant neoplasm of temporal lobe |
C71.3 | Malignant neoplasm of parietal lobe |
C71.4 | Malignant neoplasm of occipital lobe |
C71.5 | Malignant neoplasm of cerebral ventricle |
C71.6 | Malignant neoplasm of cerebellum |
C71.7 | Malignant neoplasm of brain stem |
C71.8 | Malignant neoplasm of overlapping sites of brain |
C71.9 | Malignant neoplasm of brain, unspecified |
C72.0 | Malignant neoplasm of spinal cord |
C72.1 | Malignant neoplasm of cauda equina |
C72.21 | Malignant neoplasm of right olfactory nerve |
C72.22 | Malignant neoplasm of left olfactory nerve |
C72.31 | Malignant neoplasm of right optic nerve |
C72.32 | Malignant neoplasm of left optic nerve |
C72.41 | Malignant neoplasm of right acoustic nerve |
C72.42 | Malignant neoplasm of left acoustic nerve |
C72.59 | Malignant neoplasm of other cranial nerves |
C75.1 | Malignant neoplasm of pituitary gland |
C75.2 | Malignant neoplasm of craniopharyngeal duct |
C75.3 | Malignant neoplasm of pineal gland |
C79.31 | Secondary malignant neoplasm of brain |
D18.09 | Hemangioma of other sites |
D31.91 | Benign neoplasm of unspecified part of right eye |
D31.92 | Benign neoplasm of unspecified part of left eye |
D32.0 | Benign neoplasm of cerebral meninges |
D32.9 | Benign neoplasm of meninges, unspecified |
D33.0 | Benign neoplasm of brain, supratentorial |
D33.1 | Benign neoplasm of brain, infratentorial |
D33.2 | Benign neoplasm of brain, unspecified |
D33.3 | Benign neoplasm of cranial nerves |
D35.2 | Benign neoplasm of pituitary gland |
D35.3 | Benign neoplasm of craniopharyngeal duct |
D35.4 | Benign neoplasm of pineal gland |
D42.0 | Neoplasm of uncertain behavior of cerebral meninges |
D42.1 | Neoplasm of uncertain behavior of spinal meninges |
D42.9 | Neoplasm of uncertain behavior of meninges, unspecified |
D43.0 | Neoplasm of uncertain behavior of brain, supratentorial |
D43.1 | Neoplasm of uncertain behavior of brain, infratentorial |
D43.2 | Neoplasm of uncertain behavior of brain, unspecified |
D43.4 | Neoplasm of uncertain behavior of spinal cord |
D44.3 | Neoplasm of uncertain behavior of pituitary gland |
D44.4 | Neoplasm of uncertain behavior of craniopharyngeal duct |
D44.5 | Neoplasm of uncertain behavior of pineal gland |
D49.6 | Neoplasm of unspecified behavior of brain |
H05.00 | Unspecified acute inflammation of orbit |
H05.011 | Cellulitis of right orbit |
H05.012 | Cellulitis of left orbit |
H05.013 | Cellulitis of bilateral orbits |
H05.021 | Osteomyelitis of right orbit |
H05.022 | Osteomyelitis of left orbit |
H05.023 | Osteomyelitis of bilateral orbits |
H05.031 | Periostitis of right orbit |
H05.032 | Periostitis of left orbit |
H05.033 | Periostitis of bilateral orbits |
H05.041 | Tenonitis of right orbit |
H05.042 | Tenonitis of left orbit |
H05.043 | Tenonitis of bilateral orbits |
H05.10 | Unspecified chronic inflammatory disorders of orbit |
H05.111 | Granuloma of right orbit |
H05.112 | Granuloma of left orbit |
H05.113 | Granuloma of bilateral orbits |
H05.121 | Orbital myositis, right orbit |
H05.122 | Orbital myositis, left orbit |
H05.123 | Orbital myositis, bilateral |
H05.20 | Unspecified exophthalmos |
H05.211 | Displacement (lateral) of globe, right eye |
H05.212 | Displacement (lateral) of globe, left eye |
H05.213 | Displacement (lateral) of globe, bilateral |
H05.221 | Edema of right orbit |
H05.222 | Edema of left orbit |
H05.223 | Edema of bilateral orbit |
H05.231 | Hemorrhage of right orbit |
H05.232 | Hemorrhage of left orbit |
H05.233 | Hemorrhage of bilateral orbit |
H05.241 | Constant exophthalmos, right eye |
H05.242 | Constant exophthalmos, left eye |
H05.243 | Constant exophthalmos, bilateral |
H05.251 | Intermittent exophthalmos, right eye |
H05.252 | Intermittent exophthalmos, left eye |
H05.253 | Intermittent exophthalmos, bilateral |
H05.261 | Pulsating exophthalmos, right eye |
H05.262 | Pulsating exophthalmos, left eye |
H05.263 | Pulsating exophthalmos, bilateral |
H05.30 | Unspecified deformity of orbit |
H05.311 | Atrophy of right orbit |
H05.312 | Atrophy of left orbit |
H05.313 | Atrophy of bilateral orbit |
H05.321 | Deformity of right orbit due to bone disease |
H05.322 | Deformity of left orbit due to bone disease |
H05.323 | Deformity of bilateral orbits due to bone disease |
H05.331 | Deformity of right orbit due to trauma or surgery |
H05.332 | Deformity of left orbit due to trauma or surgery |
H05.333 | Deformity of bilateral orbits due to trauma or surgery |
H05.341 | Enlargement of right orbit |
H05.342 | Enlargement of left orbit |
H05.343 | Enlargement of bilateral orbits |
H05.351 | Exostosis of right orbit |
H05.352 | Exostosis of left orbit |
H05.353 | Exostosis of bilateral orbits |
H05.401 | Unspecified enophthalmos, right eye |
H05.402 | Unspecified enophthalmos, left eye |
H05.403 | Unspecified enophthalmos, bilateral |
H05.411 | Enophthalmos due to atrophy of orbital tissue, right eye |
H05.412 | Enophthalmos due to atrophy of orbital tissue, left eye |
H05.413 | Enophthalmos due to atrophy of orbital tissue, bilateral |
H05.421 | Enophthalmos due to trauma or surgery, right eye |
H05.422 | Enophthalmos due to trauma or surgery, left eye |
H05.423 | Enophthalmos due to trauma or surgery, bilateral |
H05.51 | Retained (old) foreign body following penetrating wound of right orbit |
H05.52 | Retained (old) foreign body following penetrating wound of left orbit |
H05.53 | Retained (old) foreign body following penetrating wound of bilateral orbits |
H05.811 | Cyst of right orbit |
H05.812 | Cyst of left orbit |
H05.813 | Cyst of bilateral orbits |
H05.821 | Myopathy of extraocular muscles, right orbit |
H05.822 | Myopathy of extraocular muscles, left orbit |
H05.823 | Myopathy of extraocular muscles, bilateral |
H05.89 | Other disorders of orbit |
H05.9 | Unspecified disorder of orbit |
H40.001 | Preglaucoma, unspecified, right eye |
H40.002 | Preglaucoma, unspecified, left eye |
H40.003 | Preglaucoma, unspecified, bilateral |
H40.011 | Open angle with borderline findings, low risk, right eye |
H40.012 | Open angle with borderline findings, low risk, left eye |
H40.013 | Open angle with borderline findings, low risk, bilateral |
H40.021 | Open angle with borderline findings, high risk, right eye |
H40.022 | Open angle with borderline findings, high risk, left eye |
H40.023 | Open angle with borderline findings, high risk, bilateral |
H40.031 | Anatomical narrow angle, right eye |
H40.032 | Anatomical narrow angle, left eye |
H40.033 | Anatomical narrow angle, bilateral |
H40.041 | Steroid responder, right eye |
H40.042 | Steroid responder, left eye |
H40.043 | Steroid responder, bilateral |
H40.051 | Ocular hypertension, right eye |
H40.052 | Ocular hypertension, left eye |
H40.053 | Ocular hypertension, bilateral |
H40.061 | Primary angle closure without glaucoma damage, right eye |
H40.062 | Primary angle closure without glaucoma damage, left eye |
H40.063 | Primary angle closure without glaucoma damage, bilateral |
H40.10X0 | Unspecified open-angle glaucoma, stage unspecified |
H40.10X1 | Unspecified open-angle glaucoma, mild stage |
H40.10X2 | Unspecified open-angle glaucoma, moderate stage |
H40.10X3 | Unspecified open-angle glaucoma, severe stage |
H40.10X4 | Unspecified open-angle glaucoma, indeterminate stage |
H40.1110 | Primary open-angle glaucoma, right eye, stage unspecified |
H40.1111 | Primary open-angle glaucoma, right eye, mild stage |
H40.1112 | Primary open-angle glaucoma, right eye, moderate stage |
H40.1113 | Primary open-angle glaucoma, right eye, severe stage |
H40.1114 | Primary open-angle glaucoma, right eye, indeterminate stage |
H40.1120 - H40.1124 | Primary open-angle glaucoma, left eye, stage unspecified - Primary open-angle glaucoma, left eye, indeterminate stage |
H40.1130 - H40.1134 | Primary open-angle glaucoma, bilateral, stage unspecified - Primary open-angle glaucoma, bilateral, indeterminate stage |
H40.1210 | Low-tension glaucoma, right eye, stage unspecified |
H40.1211 | Low-tension glaucoma, right eye, mild stage |
H40.1212 | Low-tension glaucoma, right eye, moderate stage |
H40.1213 | Low-tension glaucoma, right eye, severe stage |
H40.1214 | Low-tension glaucoma, right eye, indeterminate stage |
H40.1220 | Low-tension glaucoma, left eye, stage unspecified |
H40.1221 | Low-tension glaucoma, left eye, mild stage |
H40.1222 | Low-tension glaucoma, left eye, moderate stage |
H40.1223 | Low-tension glaucoma, left eye, severe stage |
H40.1224 | Low-tension glaucoma, left eye, indeterminate stage |
H40.1230 | Low-tension glaucoma, bilateral, stage unspecified |
H40.1231 | Low-tension glaucoma, bilateral, mild stage |
H40.1232 | Low-tension glaucoma, bilateral, moderate stage |
H40.1233 | Low-tension glaucoma, bilateral, severe stage |
H40.1234 | Low-tension glaucoma, bilateral, indeterminate stage |
H40.1310 | Pigmentary glaucoma, right eye, stage unspecified |
H40.1311 | Pigmentary glaucoma, right eye, mild stage |
H40.1312 | Pigmentary glaucoma, right eye, moderate stage |
H40.1313 | Pigmentary glaucoma, right eye, severe stage |
H40.1314 | Pigmentary glaucoma, right eye, indeterminate stage |
H40.1320 | Pigmentary glaucoma, left eye, stage unspecified |
H40.1321 | Pigmentary glaucoma, left eye, mild stage |
H40.1322 | Pigmentary glaucoma, left eye, moderate stage |
H40.1323 | Pigmentary glaucoma, left eye, severe stage |
H40.1324 | Pigmentary glaucoma, left eye, indeterminate stage |
H40.1330 | Pigmentary glaucoma, bilateral, stage unspecified |
H40.1331 | Pigmentary glaucoma, bilateral, mild stage |
H40.1332 | Pigmentary glaucoma, bilateral, moderate stage |
H40.1333 | Pigmentary glaucoma, bilateral, severe stage |
H40.1334 | Pigmentary glaucoma, bilateral, indeterminate stage |
H40.1410 | Capsular glaucoma with pseudoexfoliation of lens, right eye, stage unspecified |
H40.1411 | Capsular glaucoma with pseudoexfoliation of lens, right eye, mild stage |
H40.1412 | Capsular glaucoma with pseudoexfoliation of lens, right eye, moderate stage |
H40.1413 | Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage |
H40.1414 | Capsular glaucoma with pseudoexfoliation of lens, right eye, indeterminate stage |
H40.1420 | Capsular glaucoma with pseudoexfoliation of lens, left eye, stage unspecified |
H40.1421 | Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stage |
H40.1422 | Capsular glaucoma with pseudoexfoliation of lens, left eye, moderate stage |
H40.1423 | Capsular glaucoma with pseudoexfoliation of lens, left eye, severe stage |
H40.1424 | Capsular glaucoma with pseudoexfoliation of lens, left eye, indeterminate stage |
H40.1430 | Capsular glaucoma with pseudoexfoliation of lens, bilateral, stage unspecified |
H40.1431 | Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stage |
H40.1432 | Capsular glaucoma with pseudoexfoliation of lens, bilateral, moderate stage |
H40.1433 | Capsular glaucoma with pseudoexfoliation of lens, bilateral, severe stage |
H40.1434 | Capsular glaucoma with pseudoexfoliation of lens, bilateral, indeterminate stage |
H40.1493 | Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, severe stage |
H40.151 | Residual stage of open-angle glaucoma, right eye |
H40.152 | Residual stage of open-angle glaucoma, left eye |
H40.153 | Residual stage of open-angle glaucoma, bilateral |
H40.20X0 | Unspecified primary angle-closure glaucoma, stage unspecified |
H40.20X1 | Unspecified primary angle-closure glaucoma, mild stage |
H40.20X2 | Unspecified primary angle-closure glaucoma, moderate stage |
H40.20X3 | Unspecified primary angle-closure glaucoma, severe stage |
H40.20X4 | Unspecified primary angle-closure glaucoma, indeterminate stage |
H40.211 | Acute angle-closure glaucoma, right eye |
H40.212 | Acute angle-closure glaucoma, left eye |
H40.213 | Acute angle-closure glaucoma, bilateral |
H40.2210 | Chronic angle-closure glaucoma, right eye, stage unspecified |
H40.2211 | Chronic angle-closure glaucoma, right eye, mild stage |
H40.2212 | Chronic angle-closure glaucoma, right eye, moderate stage |
H40.2213 | Chronic angle-closure glaucoma, right eye, severe stage |
H40.2214 | Chronic angle-closure glaucoma, right eye, indeterminate stage |
H40.2220 | Chronic angle-closure glaucoma, left eye, stage unspecified |
H40.2221 | Chronic angle-closure glaucoma, left eye, mild stage |
H40.2222 | Chronic angle-closure glaucoma, left eye, moderate stage |
H40.2223 | Chronic angle-closure glaucoma, left eye, severe stage |
H40.2224 | Chronic angle-closure glaucoma, left eye, indeterminate stage |
H40.2230 | Chronic angle-closure glaucoma, bilateral, stage unspecified |
H40.2231 | Chronic angle-closure glaucoma, bilateral, mild stage |
H40.2232 | Chronic angle-closure glaucoma, bilateral, moderate stage |
H40.2233 | Chronic angle-closure glaucoma, bilateral, severe stage |
H40.2234 | Chronic angle-closure glaucoma, bilateral, indeterminate stage |
H40.231 | Intermittent angle-closure glaucoma, right eye |
H40.232 | Intermittent angle-closure glaucoma, left eye |
H40.233 | Intermittent angle-closure glaucoma, bilateral |
H40.241 | Residual stage of angle-closure glaucoma, right eye |
H40.242 | Residual stage of angle-closure glaucoma, left eye |
H40.243 | Residual stage of angle-closure glaucoma, bilateral |
H40.31X0 | Glaucoma secondary to eye trauma, right eye, stage unspecified |
H40.31X1 | Glaucoma secondary to eye trauma, right eye, mild stage |
H40.31X2 | Glaucoma secondary to eye trauma, right eye, moderate stage |
H40.31X3 | Glaucoma secondary to eye trauma, right eye, severe stage |
H40.31X4 | Glaucoma secondary to eye trauma, right eye, indeterminate stage |
H40.32X0 | Glaucoma secondary to eye trauma, left eye, stage unspecified |
H40.32X1 | Glaucoma secondary to eye trauma, left eye, mild stage |
H40.32X2 | Glaucoma secondary to eye trauma, left eye, moderate stage |
H40.32X3 | Glaucoma secondary to eye trauma, left eye, severe stage |
H40.32X4 | Glaucoma secondary to eye trauma, left eye, indeterminate stage |
H40.33X0 | Glaucoma secondary to eye trauma, bilateral, stage unspecified |
H40.33X1 | Glaucoma secondary to eye trauma, bilateral, mild stage |
H40.33X2 | Glaucoma secondary to eye trauma, bilateral, moderate stage |
H40.33X3 | Glaucoma secondary to eye trauma, bilateral, severe stage |
H40.33X4 | Glaucoma secondary to eye trauma, bilateral, indeterminate stage |
H40.41X0 | Glaucoma secondary to eye inflammation, right eye, stage unspecified |
H40.41X1 | Glaucoma secondary to eye inflammation, right eye, mild stage |
H40.41X2 | Glaucoma secondary to eye inflammation, right eye, moderate stage |
H40.41X3 | Glaucoma secondary to eye inflammation, right eye, severe stage |
H40.41X4 | Glaucoma secondary to eye inflammation, right eye, indeterminate stage |
H40.42X0 | Glaucoma secondary to eye inflammation, left eye, stage unspecified |
H40.42X1 | Glaucoma secondary to eye inflammation, left eye, mild stage |
H40.42X2 | Glaucoma secondary to eye inflammation, left eye, moderate stage |
H40.42X3 | Glaucoma secondary to eye inflammation, left eye, severe stage |
H40.42X4 | Glaucoma secondary to eye inflammation, left eye, indeterminate stage |
H40.43X0 | Glaucoma secondary to eye inflammation, bilateral, stage unspecified |
H40.43X1 | Glaucoma secondary to eye inflammation, bilateral, mild stage |
H40.43X2 | Glaucoma secondary to eye inflammation, bilateral, moderate stage |
H40.43X3 | Glaucoma secondary to eye inflammation, bilateral, severe stage |
H40.43X4 | Glaucoma secondary to eye inflammation, bilateral, indeterminate stage |
H40.51X0 | Glaucoma secondary to other eye disorders, right eye, stage unspecified |
H40.51X1 | Glaucoma secondary to other eye disorders, right eye, mild stage |
H40.51X2 | Glaucoma secondary to other eye disorders, right eye, moderate stage |
H40.51X3 | Glaucoma secondary to other eye disorders, right eye, severe stage |
H40.51X4 | Glaucoma secondary to other eye disorders, right eye, indeterminate stage |
H40.52X0 | Glaucoma secondary to other eye disorders, left eye, stage unspecified |
H40.52X1 | Glaucoma secondary to other eye disorders, left eye, mild stage |
H40.52X2 | Glaucoma secondary to other eye disorders, left eye, moderate stage |
H40.52X3 | Glaucoma secondary to other eye disorders, left eye, severe stage |
H40.52X4 | Glaucoma secondary to other eye disorders, left eye, indeterminate stage |
H40.53X0 | Glaucoma secondary to other eye disorders, bilateral, stage unspecified |
H40.53X1 | Glaucoma secondary to other eye disorders, bilateral, mild stage |
H40.53X2 | Glaucoma secondary to other eye disorders, bilateral, moderate stage |
H40.53X3 | Glaucoma secondary to other eye disorders, bilateral, severe stage |
H40.53X4 | Glaucoma secondary to other eye disorders, bilateral, indeterminate stage |
H40.61X0 | Glaucoma secondary to drugs, right eye, stage unspecified |
H40.61X1 | Glaucoma secondary to drugs, right eye, mild stage |
H40.61X2 | Glaucoma secondary to drugs, right eye, moderate stage |
H40.61X3 | Glaucoma secondary to drugs, right eye, severe stage |
H40.61X4 | Glaucoma secondary to drugs, right eye, indeterminate stage |
H40.62X0 | Glaucoma secondary to drugs, left eye, stage unspecified |
H40.62X1 | Glaucoma secondary to drugs, left eye, mild stage |
H40.62X2 | Glaucoma secondary to drugs, left eye, moderate stage |
H40.62X3 | Glaucoma secondary to drugs, left eye, severe stage |
H40.62X4 | Glaucoma secondary to drugs, left eye, indeterminate stage |
H40.63X0 | Glaucoma secondary to drugs, bilateral, stage unspecified |
H40.63X1 | Glaucoma secondary to drugs, bilateral, mild stage |
H40.63X2 | Glaucoma secondary to drugs, bilateral, moderate stage |
H40.63X3 | Glaucoma secondary to drugs, bilateral, severe stage |
H40.63X4 | Glaucoma secondary to drugs, bilateral, indeterminate stage |
H40.811 | Glaucoma with increased episcleral venous pressure, right eye |
H40.812 | Glaucoma with increased episcleral venous pressure, left eye |
H40.813 | Glaucoma with increased episcleral venous pressure, bilateral |
H40.821 | Hypersecretion glaucoma, right eye |
H40.822 | Hypersecretion glaucoma, left eye |
H40.823 | Hypersecretion glaucoma, bilateral |
H40.831 | Aqueous misdirection, right eye |
H40.832 | Aqueous misdirection, left eye |
H40.833 | Aqueous misdirection, bilateral |
H40.89 | Other specified glaucoma |
H40.9 | Unspecified glaucoma |
H42 | Glaucoma in diseases classified elsewhere |
H44.40 | Unspecified hypotony of eye |
H44.411 | Flat anterior chamber hypotony of right eye |
H44.412 | Flat anterior chamber hypotony of left eye |
H44.413 | Flat anterior chamber hypotony of eye, bilateral |
H44.421 | Hypotony of right eye due to ocular fistula |
H44.422 | Hypotony of left eye due to ocular fistula |
H44.423 | Hypotony of eye due to ocular fistula, bilateral |
H44.429 | Hypotony of unspecified eye due to ocular fistula |
H44.431 | Hypotony of eye due to other ocular disorders, right eye |
H44.432 | Hypotony of eye due to other ocular disorders, left eye |
H44.433 | Hypotony of eye due to other ocular disorders, bilateral |
H44.441 | Primary hypotony of right eye |
H44.442 | Primary hypotony of left eye |
H44.443 | Primary hypotony of eye, bilateral |
H47.011 | Ischemic optic neuropathy, right eye |
H47.012 | Ischemic optic neuropathy, left eye |
H47.013 | Ischemic optic neuropathy, bilateral |
H47.021 | Hemorrhage in optic nerve sheath, right eye |
H47.022 | Hemorrhage in optic nerve sheath, left eye |
H47.023 | Hemorrhage in optic nerve sheath, bilateral |
H47.031 | Optic nerve hypoplasia, right eye |
H47.032 | Optic nerve hypoplasia, left eye |
H47.033 | Optic nerve hypoplasia, bilateral |
H47.091 | Other disorders of optic nerve, not elsewhere classified, right eye |
H47.092 | Other disorders of optic nerve, not elsewhere classified, left eye |
H47.093 | Other disorders of optic nerve, not elsewhere classified, bilateral |
H47.10 | Unspecified papilledema |
H47.11 | Papilledema associated with increased intracranial pressure |
H47.12 | Papilledema associated with decreased ocular pressure |
H47.13 | Papilledema associated with retinal disorder |
H47.141 | Foster-Kennedy syndrome, right eye |
H47.142 | Foster-Kennedy syndrome, left eye |
H47.143 | Foster-Kennedy syndrome, bilateral |
H47.20 | Unspecified optic atrophy |
H47.22 | Hereditary optic atrophy |
H47.231 | Glaucomatous optic atrophy, right eye |
H47.232 | Glaucomatous optic atrophy, left eye |
H47.233 | Glaucomatous optic atrophy, bilateral |
H47.291 | Other optic atrophy, right eye |
H47.292 | Other optic atrophy, left eye |
H47.293 | Other optic atrophy, bilateral |
H47.311 | Coloboma of optic disc, right eye |
H47.312 | Coloboma of optic disc, left eye |
H47.313 | Coloboma of optic disc, bilateral |
H47.321 | Drusen of optic disc, right eye |
H47.322 | Drusen of optic disc, left eye |
H47.323 | Drusen of optic disc, bilateral |
H47.331 | Pseudopapilledema of optic disc, right eye |
H47.332 | Pseudopapilledema of optic disc, left eye |
H47.333 | Pseudopapilledema of optic disc, bilateral |
H47.391 | Other disorders of optic disc, right eye |
H47.392 | Other disorders of optic disc, left eye |
H47.393 | Other disorders of optic disc, bilateral |
H47.41 | Disorders of optic chiasm in (due to) inflammatory disorders |
H47.42 | Disorders of optic chiasm in (due to) neoplasm |
H47.43 | Disorders of optic chiasm in (due to) vascular disorders |
H47.49 | Disorders of optic chiasm in (due to) other disorders |
H47.511 | Disorders of visual pathways in (due to) inflammatory disorders, right side |
H47.512 | Disorders of visual pathways in (due to) inflammatory disorders, left side |
H47.521 | Disorders of visual pathways in (due to) neoplasm, right side |
H47.522 | Disorders of visual pathways in (due to) neoplasm, left side |
H47.531 | Disorders of visual pathways in (due to) vascular disorders, right side |
H47.532 | Disorders of visual pathways in (due to) vascular disorders, left side |
H47.9 | Unspecified disorder of visual pathways |
H53.40 | Unspecified visual field defects |
H53.411 | Scotoma involving central area, right eye |
H53.412 | Scotoma involving central area, left eye |
H53.413 | Scotoma involving central area, bilateral |
H53.421 | Scotoma of blind spot area, right eye |
H53.422 | Scotoma of blind spot area, left eye |
H53.423 | Scotoma of blind spot area, bilateral |
H53.431 | Sector or arcuate defects, right eye |
H53.432 | Sector or arcuate defects, left eye |
H53.433 | Sector or arcuate defects, bilateral |
H53.451 | Other localized visual field defect, right eye |
H53.452 | Other localized visual field defect, left eye |
H53.453 | Other localized visual field defect, bilateral |
H53.481 | Generalized contraction of visual field, right eye |
H53.482 | Generalized contraction of visual field, left eye |
H53.483 | Generalized contraction of visual field, bilateral |
Q14.2 | Congenital malformation of optic disc |
Q14.8 | Other congenital malformations of posterior segment of eye |
Q15.0 | Congenital glaucoma |
S04.039S | Injury of optic tract and pathways, unspecified side, sequela |
S04.041A | Injury of visual cortex, right side, initial encounter |
S04.041D | Injury of visual cortex, right side, subsequent encounter |
S04.041S | Injury of visual cortex, right side, sequela |
S04.042A | Injury of visual cortex, left side, initial encounter |
S04.042D | Injury of visual cortex, left side, subsequent encounter |
S04.042S | Injury of visual cortex, left side, sequela |
S04.049A | Injury of visual cortex, unspecified side, initial encounter |
S04.049D | Injury of visual cortex, unspecified side, subsequent encounter |
S04.049S | Injury of visual cortex, unspecified side, sequela |
S05.10XA - S06.9X9S | Contusion of eyeball and orbital tissues, unspecified eye, initial encounter - Unspecified intracranial injury with loss of consciousness of unspecified duration, sequela |
1. 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 and be available to Medicare upon request.
2. A copy of the test results, computer analysis of the data, and appropriate data storage for future comparison in follow-up exams is recommended.
1. Report a Scanning Computerized Ophthalmic Diagnostic Imaging, Posterior Segment test with CPT code 92133 (optic nerve). This is a bilateral test, therefore no modifiers are required if both eyes are examined. A unit of “1” should be placed in the unit field of the CMS 1500 form or its electronic equivalent.
2. If only one eye is examined, the -RT or -LT modifier should be applied to the service line. A unit of “1” is placed in the unit field of the CMS 1500 form or its electronic equivalent.
3. Scanning Computerized Ophthalmic Diagnostic Imaging Posterior Segment (optic nerve) test requires general supervision by the optometrist/ophthalmologist.
4. An eye examination may be reported on the same day with Scanning Computerized Ophthalmic Diagnostic Imaging Posterior Segment (optic nerve) test if it is medically necessary.
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.