Print | ShareCPT Code: 92283 Region: 37
States covered: General guidelines if your state does not have a local coverage determination
Title: Color Vision Examination
Category
Special Ophthalmological Services
Description
Evaluating a patient’s color vision is a psychophysical test of visual function.
This Medicare carrier does not have a local coverage determination (LCD) for a color vision examination. The policy presented is a sample and is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.
Evaluating a patient’s color vision is a psychophysical test of visual function. The procedure is performed separately for each eye and measures the combined function of the retina, the optic nerve, and the intracranial visual pathway. Color vision diagnostics are used clinically to detect or monitor color vision loss due to disease at any of these locations. There are several methods of extended color vision testing.
Electronic / Digital
Anomaloscope
This Nagal Anomaloscope was originally developed in the early 1900’s and has historically been regarded as the standard to which other devices and methods are compared to for specificity and sensitivity. The current Anomaloscope (Heidelbberg Multi-Color MHC, Oculus | FDA listed, CE mark) consists of two different light sources which the subject is tasked to make best efforts at matching the two. Type I of this device uses a yellow lamp that is brightness adjusted by the subject in its brightness and a second light that the user adjusts a mix of red and yellow-green light to target long wavelength Protan-Deutan deficiencies. Type II of this device targets short wavelengths to assess Tritan deficiencies substituting the light sources with an aqua colored lamp and a mix of violet with blue-green light.
ColorDx CCT-HD®
CCT-HD (Konan Medical USA, Inc.| FDA listed, CE mark), introduced late in 2017, is a high-fidelity, cone-isolation, contrast sensitivity test which digitally presents stimuli that are tuned to the L, M, and S cone populations. Testing uses declining contrast Landolt C targets presented on a factory calibrated (with periodic prompts for user verification / calibration) IPS display yielding negligible contamination from non-targeted cone populations. Developed as a collaborative effort with the US Air Force, CCT-HD uses a Bayesian threshold method and includes both highly granular testing steps and very low contrast range testing. Subject uses a 4 button arrow pad to indicate the direction of displayed Landolt C test targets. Reporting automatically scores the test, and includes auto-trends analysis, per stimulus and response time graphing, and threshold reporting as LogCS, contrast level at threshold, and statistical assessment of standard error for clinical trials. The US Air Force has published data indicating that cone-isolation contrast sensitivity methods may have the highest sensitivity and specificity of all testing methods.
Rabin Cone Contrast (RCCT)
The Rabin CCT (Rabin Cone Contrast Test, Innova Systems) was developed in 2011 in collaboration with the US Air Force, using a cone-isolation strategy pioneered by Rabin. RCCT targets both genetic and acquired color vision deficiencies using digitally presents Bailey-Lovie letters in declining contrast on a factory calibrated screen, with periodic enforced user calibration for continued use. The subject selects a letter answer with a mouse on screen from a group of letters matching or missing the target. A proprietary threshold method is utilized to arrive at the contrast threshold for each cone population (L, M, and S cones).
CAD (Color Assessment and Diagnosis)
The CAD (City University of London | CE mark) utilizes a camouflage technique to mask luminance differences targeting both genetic and acquired deficiencies classifying type and severity. A factory calibrated monitor with user directed periodic calibrations is used to present a color targeting rectangular shape moving in one of 4 directions that the subject responds with a keypad when the movement is noticed.
Manual
Farnsworth-Munsell FM-100
The FM-100 hue (various vendors | FDA listed, CE mark) in use since 1949 is a sensitive color arrangement test for both genetic and acquired color vision deficiencies. Individual desaturated color plates are arranged in apparent sequence by the subject with the number of misplacements, or random placements along with which plates are improperly ordered indicative of the severity and type of deficiency along a “confusion-axis”. At least 85 plates in 4 separate boxes are used to administer the FM-100. Scoring requires a manual tally of numbers on the back of each plate on a polar scoring sheet and user assessment of the resultant plot. Electronic versions of this test may be highly susceptible to highly reduced sensitivity of the test depending on monitor characteristics and ambient lighting.
Farnsworth D-15
The D-15 (various vendors | FDA listed, CE mark) was introduced by Farnsworth in 1947 using a color arrangement strategy. This vocation test uses 15 colors with higher saturation compared to the FM-100 and a reference plate from which to begin the color ordering. As with the FM-100, the quantity and specific mis-ordering is indicative of the type and severity of the color deficiency, but with known reduced sensitivity especially for mild deficiencies. Scoring is a manual tally of numbers on the back of the plates with manual recording on a polar-type plot of horse-shoe shape. The D-15 test divides patients into two groups. The first group consists of patients with normal color vision and mild color deficiency; the second group consists of people with moderate and severe color deficiency. This test is not designed for screening nor to separate the color anomalous from the dichromat, but is an easy test that allows low-degree dyschromats to pass. The D-15 may separate sufficiently affected deutans from sufficiently affected protans.
The D-15 test was not devised for clinical care. The is a gap in the information and the test produces a hue “ellipsoid” – not really a hue “circle”. The gap severely limits the utility of the D-15 in diagnosing acquired color vision defects.
Caution about pseudo-isochromatic tests.
It should be noted that pseudoisochomatic tests (or “PIP” tests), whether printed or digitally presented, are not listed here as they are specifically excluded from the definition of an “extended color vision” with 92283 as “color vision testing with pseudoisochromatic plates (such as HRR or Ishihara) is not reported separately but included in the appropriate general or ophthalmological service”.
Several eye diseases affect a person’s color vision. In some cases, a functional loss of color vision will precede a loss of visual acuity or change in the visual field and an extended color vision examination may be indicated in the identification and/or follow-up of these conditions:
- Glaucoma
- Diabetes mellitus
- Diabetic retinopathy
- Macular degeneration
- Cone/rod dystrophy
- Nystagmus
- Optic neuropathies
- Retinal dystrophy
- Retinoschisis
ICD-10 Diagnosis Codes
The medical record should document medical necessity of the testing and how it will be used for clinical decision-making.
The interpretation and report should contain the following:
- Clinical findings — pertinent findings regarding the test results
- Comparative data — comparison to previous test results (if applicable)
- Clinical management — how the test results will affect management of the condition/disease
The medical record must be made available to Medicare upon request.
1. Report a color vision test with CPT code 92283. This is a bilateral test, therefore no modifiers are required if both eyes are examined and a unit of “1” is placed in the unit field of the CMS 1500 form or its electronic equivalent.
2. A color vision test requires general supervision by the optometrist/ophthalmologist.
3. An eye examination may be reported on the same day as if it is medically necessary.
This Medicare carrier has no specific utilization guidelines for extended color vision testing; however these tests are reimbursed at a frequency based on medical necessity.
In the absence of specific utilization guidelines, optometrists should adhere to CMS Ruling 95-1 (V) which states that utilization of these services should be consistent with locally acceptable standards of optometric practice.