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CPT Code: 92133  Region: 37

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

Title:  Scanning Laser - Posterior Segment (Optic Nerve)

Category
Special Ophthalmological Services

Description
Scanning computerized ophthalmic diagnostic imaging, posterior segment - optic nerve, unilateral or bilateral

DISCLAIMER

This Medicare carrier does not have a local coverage determination (LCD) for scanning computerized ophthalmic diagnostic imaging, posterior 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

Scanning Computerized Ophthalmic Diagnostic Imaging, Posterior Segment (SCODI) allows for early detection of glaucoma damage to the nerve fiber layer or optic nerve of the eye.  It is the goal of these diagnostic imaging tests to discriminate among patients with normal intraocular pressures (IOP) who have glaucoma, patients with elevated IOP who have glaucoma, and patients with elevated IOP or other suspicious findings who do not have glaucoma.

Scanning Computer Ophthalmic Diagnostic Imaging categorizes the following tests:

  • Optical Coherence Tomography (OCT)
  • Confocal Laser Scanning Ophthalmoscopy (topography)
  • Scanning Laser Polarimetry, nerve fiber analyzer

Confocal scanning laser ophthalmoscopy (topography) uses stereoscopic videographic digitized images to make quantitative topographic measurements of the optic nerve head and surrounding retina.

Scanning laser polarimetry measures change in the linear polarization of light (retardation).  It uses both a polarimeter (an optical device to measure linear polarization change) and a scanning laser ophthalmoscope, to measure the thickness of the nerve fiber layer of the retina.

Optical coherence tomography (OCT) is a non-invasive, non-contact imagining technique.  OCT produces high resolution, cross-sectional tomographic images of ocular structures and is used for the evaluation of retinal disease.

Although these techniques are different, their objective is the same in that they allow for early detection of glaucoma damage to the nerve fiber layer.  In progressive glaucoma there is an increasing loss of retinal nerve fibers, therefore, a decrease in nerve fiber thickness occurs. SCODI allows earlier detection of glaucoma and more sophisticated analysis for ongoing management.  These tests can distinguish patients with glaucomatous damage irrespective of the status of the IOP.  These tests also provide more precise methods of observation of the optic nerve head and can more accurately reveal subtle glaucomatous changes over the course of time than visual field’s and/or disc photos.  This allows earlier and more efficient efforts of treatment toward the disease process.

CLINICAL INDICATIONS

Glaucoma

Technological improvements have rendered SCODI as a valuable diagnostic tool in the diagnosis and treatment of glaucoma.  These improvements enable discernment of changes of the nerve fiber even in advanced cases of glaucoma.


Retinal Disorders

Retinal disorders are the most common causes of severe and permanent vision loss.  These technologies are valuable tools for the evaluation and treatment of patients with retinal disease, especially macular abnormalities.

These imaging techniques are useful tools to measure the effectiveness of therapy, and in determining the need for ongoing therapy, or the safety of cessation of therapy.

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, 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” is placed in the unit field of the CMS 1500 form or its electronic equivalent.

2.  Scanning Computerized Ophthalmic Diagnostic Imaging Posterior Segment (optic nerve) 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 Posterior Segment (optic nerve) test if it is medically necessary.

4.  Scanning Computerized Ophthalmic Diagnostic Imaging Posterior Segment (optic nerve) (92133) and Scanning Computerized Ophthalmic Diagnostic Imaging Posterior Segment (retina) (92134) can NOT be billed on the same day regardless of diagnosis.

UTILIZATION GUIDELINES

Glaucoma

It is recommended that only two exams/eye/year would be required to manage the patient who has glaucoma or is suspected of having glaucoma.


Retinal Disorders

It is recommended that only one exam/eye/2 months would be required to manage the patient whose primary ophthalmological condition is related to a retinal disease.  However, for those patients who are undergoing active treatment for macular degeneration or diabetic retinopathy one exam/eye/month may be appropriate for the management of their disease.

The use of fluorescein angiography, indocyanine green angiography and SCODI to study the patient’s same eye per clinical encounter may NOT be authorized.  However, SCODI and fluorescein angiography may be obtained on the patient’s same eye per clinical encounter if the medical record substantiates the need for both studies.

CATEGORIES