Wednesday, February 15, 2017

CPT 92083, 92081 - Visual Fields

Procedure code and Description

Group 1 Codes:

92081 VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT; LIMITED EXAMINATION (EG, TANGENT SCREEN, AUTOPLOT, ARC PERIMETER, OR SINGLE STIMULUS LEVEL AUTOMATED TEST, SUCH AS OCTOPUS 3 OR 7 EQUIVALENT)

92082 VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT; INTERMEDIATE EXAMINATION (EG, AT LEAST 2 ISOPTERS ON GOLDMANN PERIMETER, OR SEMIQUANTITATIVE, AUTOMATED SUPRATHRESHOLD SCREENING PROGRAM, HUMPHREY SUPRATHRESHOLD AUTOMATIC DIAGNOSTIC TEST, OCTOPUS PROGRAM 33)


92083 VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT; EXTENDED EXAMINATION (EG, GOLDMANN VISUAL FIELDS WITH AT LEAST 3 ISOPTERS PLOTTED AND STATIC DETERMINATION WITHIN THE CENTRAL 30 DEG;, OR QUANTITATIVE, AUTOMATED THRESHOLD PERIMETRY, OCTOPUS PROGRAM G-1, 32 OR 42, HUMPHREY VISUAL FIELD ANALYZER FULL THRESHOLD PROGRAMS 30-2, 24-2, OR 30/60-2)


Coverage Indications, Limitations, and/or Medical Necessity

Visual fields are examined by the use of static or kinetic perimetry. The procedure is performed separately for each eye, and measures the combined function of the retina, the optic nerve, and the intracranial visual pathway. It is used clinically to detect or monitor field loss due to disease at any of these locations. Visual fields may be determined by several methods including a tangent screen, Goldmann perimeter, and computerized automated perimeters.

Visual field examinations will be considered medically necessary under the following conditions:
Disorder of the eyelids potentially affecting the visual field.

A documented diagnosis of glaucoma.

Stabilization or progression of glaucoma can be monitored by a visual field examination, or by such services as scanning computerized ophthalmic diagnostic imaging. This evaluation must be performed at regular intervals to determine that the prescribed management is adequately controlling progression of disease to the degree possible. The frequency of such examinations is dependent on clinical judgment as well as the variability of intraocular pressure measurements (i.e., progressive increases despite treatment indicate a worsening condition), the appearance of new hemorrhages and progressive cupping of the optic nerve.

A diagnosis of glaucoma is suspected with supporting evidence documented.

A suspected diagnosis of glaucoma is evidenced by an increase in intraocular pressure over time, intraocular pressures of 22 mm Hg or more, asymmetric intraocular measurements of greater than 2 mm Hg between the two eyes, or has optic nerves suspicious for glaucoma, which may be manifested as asymmetrical cupping, a change in the cup-to-disc ratio over time, disc hemorrhage, or an absent, thinned or notched neural rim. Additional possible indicators of glaucoma suspicion are fallout of the retinal nerve fiber layer, optic atrophy (pallor of the optic nerve), corneal endothelial pigment deposits (Krukenburg's Spindle), dense pigmentation of the trabecular meshwork as evidenced by gonioscopy, pseudoexfoliation of the lens or dense exfoliative deposits on the trabecular meshwork as evidenced by gonioscopy.

A documented disorder of the optic nerve, the neurologic visual pathway, or retina.

Patients with a previously diagnosed retinal detachment do not need a pretreatment visual field examination. Additionally, patients with an established diagnosed cataract do not need a follow-up visual field unless other presenting symptomatology is documented. In patients who are about to undergo cataract extraction, who do not have glaucoma and are not glaucoma suspects, a visual field would not be indicated.

A recent intracranial hemorrhage, an intracranial mass or a recent measurement of increased intracranial pressure with or without visual symptomatology.

A recently documented occlusion and/or stenosis of cerebral and precerebral arteries, a recently diagnosed transient cerebral ischemia or giant cell arteritis.

A history of a cerebral aneurysm, pituitary tumor, occipital tumor or other condition potentially affecting the visual fields.

A visual field defect demonstrated by gross visual field testing (e.g., confrontation testing).

An initial workup for buphthalmos, congenital anomalies of the posterior segment or congenital ptosis.

A disorder of the orbit, potentially affecting the visual field (e.g. orbital tumor, thyroid disease, etc.).

A significant eye injury.

Unexplained visual loss which may be described as "trouble seeing or vision going in and out."

A pale or swollen optic nerve documented by a recent examination.

New functional limitations which may be due to visual field loss (i.e., reports by family that patient is running into things).

Medication treatment (e.g., hydroxychloroquine) which has a high risk of potentially affecting the visual system.

Initial evaluation for macular degeneration related to central vision loss or has experienced such loss resulting in vision measured at or below 20/70.

Limitations
Gross visual field testing (e.g., confrontation testing) is a part of general ophthalmological services and should not be reported separately.

Frequency of examinations for a diagnosis of macular degeneration or an experienced central vision loss (or to evaluate the results of a surgical intervention or for the possible need for surgical intervention) is dictated by stage of disease or degree of risk factors, just as with glaucoma evaluation.

Claims submitted for visual field examinations performed at unusually frequent intervals may be reviewed in order to verify that the services were medically reasonable and necessary.



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.
N/A




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.

N/A


Group 1Codes

ICD-10 CODE DESCRIPTION

A18.51 Tuberculous episcleritis

A18.53 Tuberculous chorioretinitis

A18.54 Tuberculous iridocyclitis

A18.59 Other tuberculosis of eye

A52.15 Late syphilitic neuropathy

A52.2 Asymptomatic neurosyphilis

A52.71 Late syphilitic oculopathy

B58.01 Toxoplasma chorioretinitis

C69.01 Malignant neoplasm of right conjunctiva

C69.02 Malignant neoplasm of left conjunctiva

C69.11 Malignant neoplasm of right cornea

C69.12 Malignant neoplasm of left cornea

C69.21 Malignant neoplasm of right retina

C69.22 Malignant neoplasm of left retina

C69.31 Malignant neoplasm of right choroid

C69.32 Malignant neoplasm of left choroid

C69.41 Malignant neoplasm of right ciliary body

C69.42 Malignant neoplasm of left ciliary body

C69.51 Malignant neoplasm of right lacrimal gland and duct

C69.52 Malignant neoplasm of left lacrimal gland and duct

C69.61 Malignant neoplasm of right orbit

C69.62 Malignant neoplasm of left orbit

C69.81 Malignant neoplasm of overlapping sites of right eye and adnexa

C69.82 Malignant neoplasm of overlapping sites of left eye and adnexa

C69.91 Malignant neoplasm of unspecified site of right eye

C69.92 Malignant neoplasm of unspecified site of left eye

C70.0 Malignant neoplasm of cerebral meninges

C70.1 Malignant neoplasm of spinal meninges

C70.9 Malignant neoplasm of meninges, unspecified

C71.0 Malignant neoplasm of cerebrum, except lobes and ventricles

C71.1 Malignant neoplasm of frontal lobe

C71.2 Malignant neoplasm of temporal lobe

C71.3 Malignant neoplasm of parietal lobe

C71.4 Malignant neoplasm of occipital lobe

C71.5 Malignant neoplasm of cerebral ventricle

C71.6 Malignant neoplasm of cerebellum

C71.7 Malignant neoplasm of brain stem

C71.8 Malignant neoplasm of overlapping sites of brain

C72.0 Malignant neoplasm of spinal cord

C72.21 Malignant neoplasm of right olfactory nerve

C72.22 Malignant neoplasm of left olfactory nerve

C72.31 Malignant neoplasm of right optic nerve

C72.32 Malignant neoplasm of left optic nerve

C72.41 Malignant neoplasm of right acoustic nerve

C72.42 Malignant neoplasm of left acoustic nerve

C72.59 Malignant neoplasm of other cranial nerves

C75.1 Malignant neoplasm of pituitary gland

C75.2 Malignant neoplasm of craniopharyngeal duct

C79.31 Secondary malignant neoplasm of brain

C79.32 Secondary malignant neoplasm of cerebral meninges

C79.49 Secondary malignant neoplasm of other parts of nervous system

D09.21 Carcinoma in situ of right eye

D09.22 Carcinoma in situ of left eye

D18.02 Hemangioma of intracranial structures

D18.09 Hemangioma of other sites

D31.01 Benign neoplasm of right conjunctiva

D31.02 Benign neoplasm of left conjunctiva

D31.11 Benign neoplasm of right cornea

D31.12 Benign neoplasm of left cornea

D31.21 Benign neoplasm of right retina

D31.22 Benign neoplasm of left retina

D31.31 Benign neoplasm of right choroid

D31.32 Benign neoplasm of left choroid

D31.41 Benign neoplasm of right ciliary body

D31.42 Benign neoplasm of left ciliary body

D31.51 Benign neoplasm of right lacrimal gland and duct

D31.52 Benign neoplasm of left lacrimal gland and duct

D31.61 Benign neoplasm of unspecified site of right orbit

D31.62 Benign neoplasm of unspecified site of left orbit

D31.91 Benign neoplasm of unspecified part of right eye

D31.92 Benign neoplasm of unspecified part of left eye

D32.0 Benign neoplasm of cerebral meninges

D33.0 Benign neoplasm of brain, supratentorial

D33.1 Benign neoplasm of brain, infratentorial

D33.3 Benign neoplasm of cranial nerves

D35.2 Benign neoplasm of pituitary gland

D35.3 Benign neoplasm of craniopharyngeal duct

D43.3 Neoplasm of uncertain behavior of cranial nerves

D43.8 Neoplasm of uncertain behavior of other specified parts of central nervous system

D44.3 Neoplasm of uncertain behavior of pituitary gland

D44.4 Neoplasm of uncertain behavior of craniopharyngeal duct

D48.7 Neoplasm of uncertain behavior of other specified sites

D49.81 Neoplasm of unspecified behavior of retina and choroid

D57.00 Hb-SS disease with crisis, unspecified

D57.01 Hb-SS disease with acute chest syndrome

D57.02 Hb-SS disease with splenic sequestration

D57.1 Sickle-cell disease without crisis

D57.20 Sickle-cell/Hb-C disease without crisis

D57.211 Sickle-cell/Hb-C disease with acute chest syndrome

D57.212 Sickle-cell/Hb-C disease with splenic sequestration

D57.219 Sickle-cell/Hb-C disease with crisis, unspecified

D57.80 Other sickle-cell disorders without crisis

D57.811 Other sickle-cell disorders with acute chest syndrome

D57.812 Other sickle-cell disorders with splenic sequestration

D57.819 Other sickle-cell disorders with crisis, unspecified

E05.00 Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm

E05.01 Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm

E05.10 Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or storm

E05.11 Thyrotoxicosis with toxic single thyroid nodule with thyrotoxic crisis or storm

E05.20 Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm

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