LCD/NCD Portal

L29244

 

OPTICAL COHERENCE BIOMETRY

 

02/02/2009

 

Indications and Limitations of Coverage and/or Medical Necessity

Medicare will consider the performance of OCB medically reasonable and necessary if:

• Performed preoperatively by the operating surgeon or his/her designee for the purpose of determining intraocular lens power in a patient undergoing cataract surgery.

• Generally, it is expected that the provider that is performing the cataract surgery will perform OCB.

 

CPT/HCPCS Codes

 

 

92136 OPHTHALMIC BIOMETRY BY PARTIAL COHERENCE INTERFEROMETRY WITH INTRAOCULAR LENS POWER CALCULATION

 

 

ICD-9 Codes that Support Medical Necessity

 

 

366.00 NONSENILE CATARACT UNSPECIFIED

366.01 ANTERIOR SUBCAPSULAR POLAR NONSENILE CATARACT

366.02 POSTERIOR SUBCAPSULAR POLAR NONSENILE CATARACT

366.03 CORTICAL LAMELLAR OR ZONULAR NONSENILE CATARACT

366.04 NUCLEAR NONSENILE CATARACT

366.10 SENILE CATARACT UNSPECIFIED

366.11 PSEUDOEXFOLIATION OF LENS CAPSULE

366.13 ANTERIOR SUBCAPSULAR POLAR SENILE CATARACT

366.14 POSTERIOR SUBCAPSULAR POLAR SENILE CATARACT

366.15 CORTICAL SENILE CATARACT

366.16 SENILE NUCLEAR SCLEROSIS

366.17 TOTAL OR MATURE CATARACT

366.18 HYPERMATURE CATARACT

366.19 OTHER AND COMBINED FORMS OF SENILE CATARACT

366.20 TRAUMATIC CATARACT UNSPECIFIED

366.22 TOTAL TRAUMATIC CATARACT

366.30 CATARACTA COMPLICATA UNSPECIFIED

366.32 CATARACT IN INFLAMMATORY OCULAR DISORDERS

366.33 CATARACT WITH OCULAR NEOVASCULARIZATION

366.34 CATARACT IN DEGENERATIVE OCULAR DISORDERS

366.41 DIABETIC CATARACT

366.42 TETANIC CATARACT

366.43 MYOTONIC CATARACT

366.44 CATARACT ASSOCIATED WITH OTHER SYNDROMES

366.45 TOXIC CATARACT

366.46 CATARACT ASSOCIATED WITH RADIATION AND OTHER PHYSICAL INFLUENCES

379.31 APHAKIA

379.32 SUBLUXATION OF LENS

379.33 ANTERIOR DISLOCATION OF LENS

379.34 POSTERIOR DISLOCATION OF LENS

743.30 CONGENITAL CATARACT UNSPECIFIED

743.31 CONGENITAL CAPSULAR AND SUBCAPSULAR CATARACT

743.32 CONGENITAL CORTICAL AND ZONULAR CATARACT

743.33 CONGENITAL NUCLEAR CATARACT

743.34 CONGENITAL TOTAL AND SUBTOTAL CATARACT

743.35 CONGENITAL APHAKIA

996.53 MECHANICAL COMPLICATION OF PROSTHETIC OCULAR LENS PROSTHESIS

V43.1* LENS REPLACED BY OTHER MEANS

* According to the ICD-9-CM book, diagnosis code V43.1 is a secondary diagnosis code and should not be billed as the primary diagnosis.

 

 

Documentation Requirements

 

• Medical record documentation maintained by the performing provider must clearly indicate the medical necessity of the service being billed.

o In addition, documentation that the service was performed must be included in the patient’s record.

o This information is normally found in the office/progress notes and/or procedure report.

• Documentation should support the criteria as set forth in the “Indications and Limitations of Coverage and/or Medical Necessity” section of this policy.

 

Treatment Logic

• Optical Coherence Biometry (OCB) is a new ophthalmic diagnostic test to perform ophthalmic biometry and intraocular lens (IOL) calculation without ultrasound.

• The instrument utilized is a non-invasive, non-contact device that measures axial length, corneal curvature, and anterior chamber depth taking a series of measurements.

• All measurements are stored in a computer, as well as automatically transferred to the IOL calculation program, which allows the surgeon immediate and individualized computation of IOL implant options for his/her patient.

• The method takes about one minute per eye.

 

Sources of Information and Basis for Decision

 

Eleftheriadis, H. (2003). Scientific Report, IOL Master biometry: refractive results of 100 consecutive cases. British Journal of Ophthalmology, 87, 960-963.

 

Haigis, W., Lege, B., Miller, N., & Schneider, B. (2000). Comparison of immersion ultrasound biometry and partial coherence interferometry for intraocular lens calculation according to Haigis. Graefe’s Archives of Clinical Experience in Ophthalmology, 238, 765-773. This document was used in the evaluation of the differences between OCB and the A-scan.

 

Hill, W. E. (2003). IOL power calculation accuracy. How to avoid common errors. Cataract & Refractive Surgery Today. Retrieved from http://www.crstodayarchive.com/03_archive/1003/051.html on September 13, 2005.

 

Santodomingo-Rubio, J., Mallen, E.A.H., Gilmartin, B., and Wolffsohn, J.S. (2002). Clinical Science, A new non-contact optical device for ocular biometry. British Journal of Ophthalmology, 86, 458-462.

 

02/02/2009

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

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.

 

CMS LCD L29244 Optical Coherence Biometry