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CPT Code: 92134  Region: 02

States covered:  Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, Wisconsin

Title:  Scanning Laser - Posterior Segment (Retina)

Category
Special Ophthalmological Services

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

FEE SCHEDULE



PROCEDURE DESCRIPTION

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.

CLINICAL INDICATIONS

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

COVERED DIAGNOSES

ICD-10 Diagnosis Codes



DOCUMENTATION REQUIREMENTS

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.

CODING GUIDELINES

1.  Report a Scanning Computerized Ophthalmic Diagnostic Imaging, Posterior Segment test with CPT code 92133 (retina).  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 (retina) 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 (retina) test if it is medically necessary.

UTILIZATION GUIDELINES

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.

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