LCD/NCD Portal

L28940

 

OPHTHALMOSCOPY

 

10/01/2011

 

Indications and Limitations of Coverage and/or Medical Necessity

 

Medicare will consider ophthalmoscopy (CPT Codes 92225, 92226) to be medically reasonable and necessary if any one of the following circumstances is present:

• The patient has a malignant neoplasm of the retina or choroid.

o This may appear as a single, round or oval, slightly elevated, gray or nonpigmented lesion.

• The patient has a retained (old) intraocular foreign body, either magnetic or nonmagnetic.

o Signs and symptoms may include

 a statement by the patient that something has hit his/her eye (foreign body sensation),

 normal or blurred vision,

 pain or no discomfort, and

 Tearing.

• The patient has

o retinal hemorrhage,

o edema, ischemia,

o exudates and deposits,

o hereditary retinal dystrophies or

o Peripheral retinal degeneration.

• The patient has retinal detachment with or without retinal defect.

o The patient may complain of

 light flashes,

 dark floating specks, and

 Blurred vision that becomes progressively worse.

 This may be described by the patient as “a curtain came down over my eyes.”

• The patient has retinal defects without retinal detachment.

• The patient has

o diabetic retinopathy ( e.g., background retinopathy or proliferative retinopathy),

o retinal vascular occlusion, or

o Separation of the retinal layers.

o This may be evidenced by

 microaneurysms,

 cotton wool spots,

 exudates,

 hemorrhages, or

 Fibrous proliferation.

• The patient has experienced sudden visual loss or transient visual loss.

o This may be described as trouble seeing or vision going in and out.

• The patient has

o chorioretinitis,

o chorioretinal scars or choroidal degeneration,

o dystrophies,

o hemorrhage and rupture, or

o Detachment.

• The patient has Vogt-Koyanagi syndrome.

o This disease is characterized by

 Bilateral uveitis.

 Dysacousia.

 Meningeal irritation.

 Whitening of patches of hair (poliosis).

 Vitiligo.

 Retinal detachment.

 The disease can be initiated by:

• A severe headache.

• Deep orbital pain.

• Vertigo

• Nausea.

• The patient has sustained:

o A penetrating wound to the orbit.

o Resulting in the retention of a foreign body in the eye.

• The patient has disorders of the vitreous body:

o Vitreous hemorrhage.

o Posterior vitreous detachment.

o Spots before the eyes (floaters) and flashing lights (photopsia) can be signs/symptoms of these disorders.

• The patient has posterior scleritis.

o Signs and symptoms may include:

 Severe pain and inflammation.

 Proptosis.

 Limited ocular movements.

 A loss of a portion of the visual field.

• The patient has degenerative disorders of the globe.

• The patient has retinoschisis and retinal cysts.

o Patients may complain of light flashes and floaters.

• The patient has signs and symptoms of endophthalmitis which may include

o Severe pain.

o Redness.

o Photophobia.

o Profound loss of vision.

• The patient has glaucoma or is a glaucoma suspect.

o This may be evidenced by increased intraocular pressure or progressive cupping of the optic nerve.

o The patient's medical record must meet the documentation requirements set forth in this policy (see Documentation Requirements).

• In all instances extended ophthalmoscopy must be medically necessary.

o It must add information not available from the standard evaluation services and/or information that will demonstrably affect the treatment plan.

o It is not necessary, for example, to confirm information already available by other means.

Coding Information

 

Bill Type Codes

• Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.

• Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type.

• Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

 

 

12x Hospital Inpatient (Medicare Part B only)

13x Hospital Outpatient

14x Hospital - Laboratory Services Provided to Non-patients

21x Skilled Nursing - Inpatient (Including Medicare Part A)

22x Skilled Nursing - Inpatient (Medicare Part B only)

23x Skilled Nursing - Outpatient

85x Critical Access Hospital

 

Revenue Codes

• Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.

• In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination.

• Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

 

0920 Other Diagnostic Services - General Classification

 

 

CPT/HCPCS Codes

 

 

92225 OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT, MELANOMA), WITH INTERPRETATION AND REPORT; INITIAL

92226 OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT, MELANOMA), WITH INTERPRETATION AND REPORT; SUBSEQUENT

 

ICD-9 Codes that Support Medical Necessity

 

 

115.92 HISTOPLASMOSIS RETINITIS UNSPECIFIED

130.2 CHORIORETINITIS DUE TO TOXOPLASMOSIS

190.5 MALIGNANT NEOPLASM OF RETINA

190.6 MALIGNANT NEOPLASM OF CHOROID

224.5 BENIGN NEOPLASM OF RETINA

224.6 BENIGN NEOPLASM OF CHOROID

225.1 BENIGN NEOPLASM OF CRANIAL NERVES

228.03 HEMANGIOMA OF RETINA

360.00 PURULENT ENDOPHTHALMITIS UNSPECIFIED

360.01 ACUTE ENDOPHTHALMITIS

360.02 PANOPHTHALMITIS

360.03 CHRONIC ENDOPHTHALMITIS

360.04 VITREOUS ABSCESS

360.11 SYMPATHETIC UVEITIS

360.12 PANUVEITIS

360.13 PARASITIC ENDOPHTHALMITIS UNSPECIFIED

360.19 OTHER ENDOPHTHALMITIS

360.21 PROGRESSIVE HIGH (DEGENERATIVE) MYOPIA

360.23 SIDEROSIS OF GLOBE

360.24 OTHER METALLOSIS OF GLOBE

360.50 FOREIGN BODY MAGNETIC INTRAOCULAR UNSPECIFIED

360.52 FOREIGN BODY MAGNETIC IN IRIS OR CILIARY BODY

360.54 FOREIGN BODY MAGNETIC IN VITREOUS

360.55 FOREIGN BODY MAGNETIC IN POSTERIOR WALL

360.60 FOREIGN BODY INTRAOCULAR UNSPECIFIED

360.64 FOREIGN BODY IN VITREOUS

360.65 FOREIGN BODY IN POSTERIOR WALL OF EYE

361.00 RETINAL DETACH WITH RETINAL DEFECT UNSPECIFIED

361.01 RECENT RETINAL DETACH PARTIAL WITH SINGLE DEFECT

361.02 RECENT RETINAL DETACH PARTIAL WITH MULTIPLE DEFECTS

361.03 RECENT RETINAL DETACH PARTIAL WITH GIANT TEAR

361.04 RECENT RETINAL DETACH PARTIAL WITH RETINAL DIALYSIS

361.05 RECENT RETINAL DETACH TOTAL OR SUBTOTAL

361.06 OLD RETINAL DETACH PARTIAL

361.07 OLD RETINAL DETACH TOTAL OR SUBTOTAL

361.10 RETINOSCHISIS UNSPECIFIED

361.11 FLAT RETINOSCHISIS

361.12 BULLOUS RETINOSCHISIS

361.13 PRIMARY RETINAL CYSTS

361.14 SECONDARY RETINAL CYSTS

361.19 OTHER RETINOSCHISIS AND RETINAL CYSTS

361.2 SEROUS RETINAL DETACH

361.30 RETINAL DEFECT UNSPECIFIED

361.31 ROUND HOLE OF RETINA WITHOUT DETACH

361.32 HORSESHOE TEAR OF RETINA WITHOUT DETACH

361.33 MULTIPLE DEFECTS OF RETINA WITHOUT DETACH

361.81 TRACTION DETACH OF RETINA

361.89 OTHER FORMS OF RETINAL DETACH

362.01* BACKGROUND DIABETIC RETINOPATHY

362.02* PROLIFERATIVE DIABETIC RETINOPATHY

362.03* NONPROLIFERATIVE DIABETIC RETINOPATHY NOS

362.05* MODERATE NONPROLIFERATIVE DIABETIC RETINOPATHY

362.06* SEVERE NONPROLIFERATIVE DIABETIC RETINOPATHY

362.07* DIABETIC MACULAR EDEMA

362.10 BACKGROUND RETINOPATHY UNSPECIFIED

362.11 HYPERTENSIVE RETINOPATHY

362.12 EXUDATIVE RETINOPATHY

362.13 CHANGES IN VASCULAR APPEARANCE OF RETINA

362.14 RETINAL MICROANEURYSMS NOS

362.15 RETINAL TELANGIECTASIA

362.16 RETINAL NEOVASCULARIZATION NOS

362.17 OTHER INTRARETINAL MICROVASCULAR ABNORMALITIES

362.18 RETINAL VASCULITIS

362.21 RETROLENTAL FIBROPLASIA

362.22 RETINOPATHY OF PREMATURITY, STAGE 0

362.23 RETINOPATHY OF PREMATURITY, STAGE 1

362.24 RETINOPATHY OF PREMATURITY, STAGE 2

362.25 RETINOPATHY OF PREMATURITY, STAGE 3

362.26 RETINOPATHY OF PREMATURITY, STAGE 4

362.27 RETINOPATHY OF PREMATURITY, STAGE 5

362.29 OTHER NONDIABETIC PROLIFERATIVE RETINOPATHY

362.30 RETINAL VASCULAR OCCLUSION UNSPECIFIED

362.31 CENTRAL RETINAL ARTERY OCCLUSION

362.32 RETINAL ARTERIAL BRANCH OCCLUSION

362.33 PARTIAL RETINAL ARTERIAL OCCLUSION

362.34 TRANSIENT RETINAL ARTERIAL OCCLUSION

362.35 CENTRAL RETINAL VEIN OCCLUSION

362.36 VENOUS TRIBUTARY (BRANCH) OCCLUSION OF RETINA

362.37 VENOUS ENGORGEMENT OF RETINA

362.40 RETINAL LAYER SEPARATION UNSPECIFIED

362.41 CENTRAL SEROUS RETINOPATHY

362.42 SEROUS DETACH OF RETINAL PIGMENT EPITHELIUM

362.43 HEMORRHAGIC DETACH OF RETINAL PIGMENT EPITHELIUM

362.50 MACULAR DEGENERATION (SENILE) OF RETINA UNSPECIFIED

362.51 NONEXUDATIVE SENILE MACULAR DEGENERATION OF RETINA

362.52 EXUDATIVE SENILE MACULAR DEGENERATION OF RETINA

362.53 CYSTOID MACULAR DEGENERATION OF RETINA

362.54 MACULAR CYST HOLE OR PSEUDOHOLE OF RETINA

362.55 TOXIC MACULOPATHY OF RETINA

362.56 MACULAR PUCKERING OF RETINA

362.57 DRUSEN (DEGENERATIVE) OF RETINA

362.60 PERIPHERAL RETINAL DEGENERATION UNSPECIFIED

362.61 PAVING STONE DEGENERATION OF RETINA

362.62 MICROCYSTOID DEGENERATION OF RETINA

362.63 LATTICE DEGENERATION OF RETINA

362.64 SENILE RETICULAR DEGENERATION OF RETINA

362.65 SECONDARY PIGMENTARY DEGENERATION OF RETINA

362.66 SECONDARY VITREORETINAL DEGENERATIONS

362.70 HEREDITARY RETINAL DYSTROPHY UNSPECIFIED

362.71 RETINAL DYSTROPHY IN SYSTEMIC OR CEREBRORETINAL LIPIDOSES

362.72 RETINAL DYSTROPHY IN OTHER SYSTEMIC DISORDERS AND SYNDROMES

362.73 VITREORETINAL DYSTROPHIES

362.74 PIGMENTARY RETINAL DYSTROPHY

362.75 OTHER DYSTROPHIES PRIMARILY INVOLVING THE SENSORY RETINA

362.76 DYSTROPHIES PRIMARILY INVOLVING THE RETINAL PIGMENT EPITHELIUM

362.77 RETINAL DYSTROPHIES PRIMARILY INVOLVING BRUCH'S MEMBRANE

362.81 RETINAL HEMORRHAGE

362.82 RETINAL EXUDATES AND DEPOSITS

362.83 RETINAL EDEMA

362.84 RETINAL ISCHEMIA

363.00 FOCAL CHORIORETINITIS UNSPECIFIED

363.01 FOCAL CHOROIDITIS AND CHORIORETINITIS JUXTAPAPILLARY

363.03 FOCAL CHOROIDITIS AND CHORIORETINITIS OF OTHER POSTERIOR POLE

363.04 FOCAL CHOROIDITIS AND CHORIORETINITIS PERIPHERAL

363.05 FOCAL RETINITIS AND RETINOCHOROIDITIS JUXTAPAPILLARY

363.06 FOCAL RETINITIS AND RETINOCHOROIDITIS MACULAR OR PARAMACULAR

363.07 FOCAL RETINITIS AND RETINOCHOROIDITIS OF OTHER POSTERIOR POLE

363.08 FOCAL RETINITIS AND RETINOCHOROIDITIS PERIPHERAL

363.10 DISSEMINATED CHORIORETINITIS UNSPECIFIED

363.11 DISSEMINATED CHOROIDITIS AND CHORIORETINITIS POSTERIOR POLE

363.12 DISSEMINATED CHOROIDITIS AND CHORIORETINITIS PERIPHERAL

363.13 DISSEMINATED CHOROIDITIS AND CHORIORETINITIS GENERALIZED

363.14 DISSEMINATED RETINITIS AND RETINOCHOROIDITIS METASTATIC

363.15 DISSEMINATED RETINITIS AND RETINOCHOROIDITIS PIGMENT EPITHELIOPATHY

363.20 CHORIORETINITIS UNSPECIFIED

363.21 PARS PLANITIS

363.22 HARADA'S DISEASE

363.30 CHORIORETINAL SCAR UNSPECIFIED

363.31 SOLAR RETINOPATHY

363.32 OTHER MACULAR SCARS OF RETINA

363.33 OTHER SCARS OF POSTERIOR POLE OF RETINA

363.34 PERIPHERAL SCARS OF RETINA

363.35 DISSEMINATED SCARS OF RETINA

363.40 CHOROIDAL DEGENERATION UNSPECIFIED

363.41 SENILE ATROPHY OF CHOROID

363.42 DIFFUSE SECONDARY ATROPHY OF CHOROID

363.43 ANGIOID STREAKS OF CHOROID

363.50 HEREDITARY CHOROIDAL DYSTROPHY OR ATROPHY UNSPECIFIED

363.51 CIRCUMPAPILLARY DYSTROPHY OF CHOROID PARTIAL

363.52 CIRCUMPAPILLARY DYSTROPHY OF CHOROID TOTAL

363.53 CENTRAL DYSTROPHY OF CHOROID PARTIAL

363.54 CENTRAL CHOROIDAL ATROPHY TOTAL

363.55 CHOROIDEREMIA

363.56 OTHER DIFFUSE OR GENERALIZED DYSTROPHY OF CHOROID PARTIAL

363.57 OTHER DIFFUSE OR GENERALIZED DYSTROPHY OF CHOROID TOTAL

363.61 CHOROIDAL HEMORRHAGE UNSPECIFIED

363.62 EXPULSIVE CHOROIDAL HEMORRHAGE

363.63 CHOROIDAL RUPTURE

363.70 CHOROIDAL DETACH UNSPECIFIED

363.71 SEROUS CHOROIDAL DETACH

363.72 HEMORRHAGIC CHOROIDAL DETACH

364.00 ACUTE AND SUBACUTE IRIDOCYCLITIS UNSPECIFIED

364.01 PRIMARY IRIDOCYCLITIS

364.02 RECURRENT IRIDOCYCLITIS

364.03 SECONDARY IRIDOCYCLITIS INFECTIOUS

364.04 SECONDARY IRIDOCYCLITIS NONINFECTIOUS

364.05 HYPOPYON

364.24 VOGT-KOYANAGI SYNDROME

365.00 PREGLAUCOMA UNSPECIFIED

365.01 OPEN ANGLE WITH BORDERLINE FINDINGS, LOW RISK

365.02 ANATOMICAL NARROW ANGLE BORDERLINE GLAUCOMA

365.03 STEROID RESPONDERS BORDERLINE GLAUCOMA

365.04 OCULAR HYPERTENSION

365.05 OPEN ANGLE WITH BORDERLINE FINDINGS, HIGH RISK

365.06 PRIMARY ANGLE CLOSURE WITHOUT GLAUCOMA DAMAGE

365.10 OPEN-ANGLE GLAUCOMA UNSPECIFIED

365.11 PRIMARY OPEN ANGLE GLAUCOMA

365.12 LOW TENSION OPEN-ANGLE GLAUCOMA

365.13 PIGMENTARY OPEN-ANGLE GLAUCOMA

365.14 GLAUCOMA OF CHILDHOOD

365.15 RESIDUAL STAGE OF OPEN ANGLE GLAUCOMA

365.20 PRIMARY ANGLE-CLOSURE GLAUCOMA UNSPECIFIED

365.21 INTERMITTENT ANGLE-CLOSURE GLAUCOMA

365.22 ACUTE ANGLE-CLOSURE GLAUCOMA

365.23 CHRONIC ANGLE-CLOSURE GLAUCOMA

365.24 RESIDUAL STAGE OF ANGLE-CLOSURE GLAUCOMA

365.31 CORTICOSTEROID-INDUCED GLAUCOMA GLAUCOMATOUS STAGE

365.32 CORTICOSTEROID-INDUCED GLAUCOMA RESIDUAL STAGE

365.41 GLAUCOMA ASSOCIATED WITH CHAMBER ANGLE ANOMALIES

365.42 GLAUCOMA ASSOCIATED WITH ANOMALIES OF IRIS

365.43 GLAUCOMA ASSOCIATED WITH OTHER ANTERIOR SEGMENT ANOMALIES

365.44 GLAUCOMA ASSOCIATED WITH SYSTEMIC SYNDROMES

365.51 PHACOLYTIC GLAUCOMA

365.52 PSEUDOEXFOLIATION GLAUCOMA

365.59 GLAUCOMA ASSOCIATED WITH OTHER LENS DISORDERS

365.60 GLAUCOMA ASSOCIATED WITH UNSPECIFIED OCULAR DISORDER

365.61 GLAUCOMA ASSOCIATED WITH PUPILLARY BLOCK

365.62 GLAUCOMA ASSOCIATED WITH OCULAR INFLAMMATIONS

365.63 GLAUCOMA ASSOCIATED WITH VASCULAR DISORDERS OF EYE

365.64 GLAUCOMA ASSOCIATED WITH TUMORS OR CYSTS

365.65 GLAUCOMA ASSOCIATED WITH OCULAR TRAUMA

365.70 GLAUCOMA STAGE, UNSPECIFIED

365.71 MILD STAGE GLAUCOMA

365.72 MODERATE STAGE GLAUCOMA

365.73 SEVERE STAGE GLAUCOMA

365.74 INDETERMINATE STAGE GLAUCOMA

365.81 HYPERSECRETION GLAUCOMA

365.82 GLAUCOMA WITH INCREASED EPISCLERAL VENOUS PRESSURE

365.83 AQUEOUS MISDIRECTION

365.89 OTHER SPECIFIED GLAUCOMA

365.9 UNSPECIFIED GLAUCOMA

368.11 SUDDEN VISUAL LOSS

368.12 TRANSIENT VISUAL LOSS

368.15 OTHER VISUAL DISTORTIONS AND ENTOPTIC PHENOMENA

376.6 RETAINED (OLD) FOREIGN BODY FOLLOWING PENETRATING WOUND OF ORBIT

377.00 PAPILLEDEMA UNSPECIFIED

377.10 OPTIC ATROPHY UNSPECIFIED

377.11 PRIMARY OPTIC ATROPHY

377.12 POSTINFLAMMATORY OPTIC ATROPHY

377.13 OPTIC ATROPHY ASSOCIATED WITH RETINAL DYSTROPHIES

377.14 GLAUCOMATOUS ATROPHY (CUPPING) OF OPTIC DISC

377.15 PARTIAL OPTIC ATROPHY

377.16 HEREDITARY OPTIC ATROPHY

377.21 DRUSEN OF OPTIC DISC

377.22 CRATER-LIKE HOLES OF OPTIC DISC

377.23 COLOBOMA OF OPTIC DISC

377.24 PSEUDOPAPILLEDEMA

377.30 OPTIC NEURITIS UNSPECIFIED

377.33 NUTRITIONAL OPTIC NEUROPATHY

377.34 TOXIC OPTIC NEUROPATHY

377.41 ISCHEMIC OPTIC NEUROPATHY

377.42 HEMORRHAGE IN OPTIC NERVE SHEATHS

377.43 OPTIC NERVE HYPOPLASIA

377.49 OTHER DISORDERS OF OPTIC NERVE

379.07 POSTERIOR SCLERITIS

379.21 VITREOUS DEGENERATION

379.22 CRYSTALLINE DEPOSITS IN VITREOUS

379.23 VITREOUS HEMORRHAGE

379.24 OTHER VITREOUS OPACITIES

379.25 VITREOUS MEMBRANES AND STRANDS

379.26 VITREOUS PROLAPSE

379.27 VITREOMACULAR ADHESION

379.29 OTHER DISORDERS OF VITREOUS

379.32 SUBLUXATION OF LENS

379.34 POSTERIOR DISLOCATION OF LENS

743.51 VITREOUS ANOMALIES CONGENITAL

743.52 FUNDUS COLOBOMA

743.53 CHORIORETINAL DEGENERATION CONGENITAL

743.54 CONGENITAL FOLDS AND CYSTS OF POSTERIOR SEGMENT

743.55 CONGENITAL MACULAR CHANGES

743.56 OTHER RETINAL CHANGES CONGENITAL

743.57 SPECIFIED CONGENITAL ANOMALIES OF OPTIC DISC

743.58 VASCULAR ANOMALIES CONGENITAL

743.59 OTHER CONGENITAL ANOMALIES OF POSTERIOR SEGMENT

759.5 TUBEROUS SCLEROSIS

759.6 OTHER CONGENITAL HAMARTOSES NOT ELSEWHERE CLASSIFIED

759.82 MARFAN SYNDROME

871.0 OCULAR LACERATION WITHOUT PROLAPSE OF INTRAOCULAR TISSUE

871.1 OCULAR LACERATION WITH PROLAPSE OR EXPOSURE OF INTRAOCULAR TISSUE

871.2 RUPTURE OF EYE WITH PARTIAL LOSS OF INTRAOCULAR TISSUE

871.3 AVULSION OF EYE

871.4 UNSPECIFIED LACERATION OF EYE

871.5 PENETRATION OF EYEBALL WITH MAGNETIC FOREIGN BODY

871.6 PENETRATION OF EYEBALL WITH (NONMAGNETIC) FOREIGN BODY

871.7 UNSPECIFIED OCULAR PENETRATION

871.9 UNSPECIFIED OPEN WOUND OF EYEBALL

921.3 CONTUSION OF EYEBALL

998.82 CATARACT FRAGMENTS IN EYE FOLLOWING CATARACT SURGERY

* To ensure reimbursement for this service when billing ICD-9-CM code 362.07, dual diagnoses must be submitted. An ICD-9-CM code from the following diagnosis codes 362.01-362.03, 362.05 or 362.06 (representing diabetic retinopathy) must be reported with ICD-9-CM code 362.07 (diabetic macular edema).

 

 

Documentation Requirements

• Medical record documentation (e.g., office/progress notes) maintained by the ordering/referring physician must indicate the medical necessity of the extended ophthalmoscopy exam.

• The medical records must include the following:

o The complaint or symptomatology necessitating the extended ophthalmoscopy exam.

o Notation that the eye examined was dilated and the drug used.

o The method of examination (e.g., lens, instrument used).

o A detailed drawing of the retina showing anatomy in the patient as seen at time of examination, including the pathology found and a legible narrative report of the findings.

o An assessment of the change from previous examinations when performing follow-up services (92226).

• If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of the ophthalmoscopy exam results and interpretation, along with copies of the ordering/referring physician’s order for the ophthalmoscopy.

o The physician must state the clinical indication/medical necessity for the ophthalmoscopy in the order for the exam.

• Documentation in the medical record for a diagnosis of glaucoma (ICD-9 Code 365.00-365.9) must include all of the following:

o A detailed drawing of the optic nerve.

o Documentation of cupping, disc rim, pallor, and slope.

o Documentation of any surrounding pathology around the optic nerve.

 

Treatment Logic

• Extended ophthalmoscopy is an assessment of the posterior segment of the eye (vitreous, retina, optic disc, choroids, etc.) with the pupil dilated using indirect ophthalmoscopy or slit lamp biomicroscopy.

o These techniques employ an additional diagnostic tool (e.g., 3-mirror lens, 20-diopter lens, 90-diopter lens, scleral depression) and include a detailed drawing of the retina.

o Extended ophthalmoscopy provides a high intensity illumination, stereoscopic, wide field of view of the ocular fundus for detection and/or evaluation of vitreoretinal pathology.

• Extended ophthalmoscopy codes are reserved for the meticulous evaluation of the eye in detailed documentation of a severe ophthalmologic problem needing continued follow-up, which cannot be sufficiently evaluated by photography.

 

Sources of Information and Basis for Decision

 

FCSO LCD 29242, Ophthalmoscopy, 10/01/2011. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

Yanoff. (2004). Ophthalmology(2nd ed.). St. Louis, MO: Mosby.

 

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

CMS LCD L28940 Ophthalmoscopy