LCD/NCD Portal

L29122

 

COMPUTERIZED CORNEAL TOPOGRAPHY

 

02/02/2009

 

Indications and Limitations of Coverage and/or Medical Necessity

• Keratoplasty that treats specific lesions of the cornea, such as phototherapeutic keratectomy that removes scar tissue from the visual field, deals with an abnormality of the eye and is NOT cosmetic surgery.

• Such cases may be covered under §1862(a) (1) (A) of the Act (CMS Pub 100-03, Chapter 1, Part 1, Section 80.7.1).

FCSO Medicare will consider Computerized Corneal Topography medically necessary under any of the following conditions:

• Pre-operatively for evaluation of irregular astigmatism prior to cataract surgery.

• Monocular diplopia.

• Bullous keratopathy.

• Post-surgical or post traumatic astigmatism, measuring at a minimum of 3.5 diopters.

• Post penetrating keratoplasty surgery.

• Post-surgical or post traumatic irregular astigmatism.

• Corneal dystrophy.

• Complications of transplanted cornea.

• Post traumatic corneal scarring.

• Keratoconus.

• Pterygium and/or corneal ectasia that cause visual impairment.

 

Limitations

• Corneal topography will only be allowed for a pre-operative cataract patient if documentation supports that the patient has irregular astigmatism.

• Corneal topography is to be billed only when the diagnosis of monocular diplopia is thought to be caused by a corneal irregularity.

• Corneal Topography is a covered service for the above indications when medically reasonable and necessary only if the results will assist in defining further treatment.

o It is NOT covered for routine follow-up testing.

• Repeat testing is only indicated if a change of vision is reported in connection with one of the above listed conditions.

• Services performed for screening purposes or in the absence of associated signs, symptoms, illness or injury as indicated above, will be denied as NON-COVERED.

• Corneal Topography will be NON-COVERED if performed pre- or post-operatively in relation to a Medicare non-covered procedure, i.e., radial keratotomy.

• Per CMS Pub 100-03, Chapter 1, Part 1, Section 80.7, Refractive keratoplasty is surgery to reshape the cornea of the eye to correct vision problems such as myopia (nearsightedness) and hyperopia (farsightedness).

o Refractive keratoplasty procedures include:

 Keratomileusis, in which the front of the cornea is removed, frozen, reshaped, and stitched back on the eye to correct either near or farsightedness.

 Keratophakia, in which a reshaped donor cornea is inserted in the eye to correct farsightedness.

 Radial keratotomy, in which spoke-like slits are cut in the cornea to weaken and flatten the normally curved central portion to correct nearsightedness.

• The correction of common refractive errors by eyeglasses, contact lenses or other prosthetic devices is specifically excluded from coverage.

o The use of radial keratotomy and/or keratoplasty (Refractive Surgeries) for the purpose of refractive error compensation is considered a substitute or alternative to eye glasses or contact lenses which are specifically excluded by §1862 (a)(7) of the Act (except in certain cases in connection with cataract surgery). In addition, many in the medical community consider such procedures cosmetic surgery which is excluded by §§1862 (a) (10) of the Act.

o Therefore, radial keratotomy and keratoplasty (Refractive Surgeries) to treat refractive defects are not covered.

 

CPT/HCPCS Codes

 

 

92025 COMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT

 

 

ICD-9 Codes that Support Medical Necessity

 

 

367.21* REGULAR ASTIGMATISM

367.22* IRREGULAR ASTIGMATISM

368.2 DIPLOPIA

371.00 CORNEAL OPACITY UNSPECIFIED

371.23 BULLOUS KERATOPATHY

371.46 NODULAR DEGENERATION OF CORNEA

371.48 PERIPHERAL DEGENERATIONS OF CORNEA

371.52 OTHER ANTERIOR CORNEAL DYSTROPHIES

371.60 KERATOCONUS UNSPECIFIED

371.61 KERATOCONUS STABLE CONDITION

371.62 KERATOCONUS ACUTE HYDROPS

371.71 CORNEAL ECTASIA

372.40 PTERYGIUM UNSPECIFIED

372.41 PERIPHERAL PTERYGIUM STATIONARY

372.42 PERIPHERAL PTERYGIUM PROGRESSIVE

372.43 CENTRAL PTERYGIUM

372.44 DOUBLE PTERYGIUM

372.45 RECURRENT PTERYGIUM

372.52 PSEUDOPTERYGIUM

996.51 MECHANICAL COMPLICATION OF PROSTHETIC CORNEAL GRAFT

V42.5* CORNEA REPLACED BY TRANSPLANT

V45.61* CATARACT EXTRACTION STATUS

V45.69* OTHER STATES FOLLOWING SURGERY OF EYE AND ADNEXA

*ICD-9-CM code 367.21 must be accompanied by diagnosis code V45.61 or V45.69

 

*ICD-9-CM code 367.22 must be accompanied by diagnosis code V45.61 or V45.69

 

*According to the ICD-9-CM book, diagnosis codes V42.5, V45.61 and V45.69 are secondary diagnosis codes and should not be billed as the primary diagnosis.

 

 

Documentation Requirements

• Medical record documentation submitted by the ordering/referring physician must indicate the medical necessity for performing the procedure and the results derived from the corneal topography procedure.

• This information is usually found in the history and physical, office/progress notes and the computerized corneal topography imaging interpretation and report.

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.

Treatment Logic

• Computerized Corneal Topography (also known as computer-assisted video keratography (CAVK) and corneal mapping is a computer assisted diagnostic imaging technique in which a special instrument projects a series of light rings on the cornea, creating a color coded map of the corneal surface as well as a cross-section profile.

• This service is used to provide a detailed map or chart of the physical features and shape of the anterior surface of the cornea.

• This permits a more accurate portrayal of the physical state of the cornea and the subtle detection of corneal surface irregularity and astigmatism.

Sources of Information and Basis for Decision

 

American Academy of Ophthalmology. (2006). Preferred Practice Pattern for Cataract in the Adult Eye. Retrieved March 30, 2007 from www.aao.org website.

 

FCSO LCD 29122, Computerized Corneal Topography, 02/02/2009. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

Fedor, . (2006). ¬Corneal Topography and Imaging. Available at http://www.emedicine.com/oph/topic711.htm

 

Rasheed, K. (2005). Pellucid Marginal degeneration. Available at http://www.emedicine.com/OPH/topic551.htm.

 

Szczotka, L. (2003). Corneal topography and contact lenses. Ophthalmology Clinics of North America 16(3). W.B. Saunders Company

 

Verdler, D. (2005). Dystrophy, Map-dot-fingerprint. Available at http://www.emedicine.com/oph/topic95.htm.

 

Wang, L.; Koch, D. (2005). Corneal Topography and its Integration into Refractive Surgery. Comprehensive Ophthalmology Update 6 (2) pp73-81.

 

Weissman, B. (2007). Keratoconus. Available at http://www.emedicine.com/oph/topic104.htm.

 

 

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 L29122 Computerized Corneal Topography