Corporate Medical Policy

Vision Services

File name: Vision Services Origination: 12/1992 Last Review: 01/2011 Next Review: 07/2012 Effective Date: 08/2011

Description

An exam is not a covered medical benefit for common vision conditions, such as , , hyperopia, and . An eye exam performed by a ophthalmologist or optometrist is a covered benefit when a specific ophthalmic disease, medical condition or infective process is being monitored or treated such as , diabetic , , , , and . Routine eye exams/care may be covered under the members benefit for vision services should the member have that benefit in their contract.

Policy

Benefits are subject to all terms, limitations and conditions of the subscriber contract.

Prior approval may be required subject to all terms, limitations and conditions of the subscriber contract

Federal Employee Program (FEP) members may have different benefits that apply. For further information please contact FEP customer service.

When service or procedure is covered

Routine eye exams (CPT 92002-92014) are covered under the medical benefit only when a disease condition of the eye is found or reasonably suspected. A list of covered diagnoses is attached. (Attachment I)

A screening test for defective vision in conjunction with a preventive medicine evaluation and management service when done in accordance with current American Academy of Pediatrics, American Academy of Family Practice, and/or Bright Futures guidelines by a physician, physician assistant, or advanced practice nurse clinician.

Visual examination without refraction (CPT 92002 - 92014) is a covered medical benefit when a disease state of the eye or known to affect the eye is present or reasonably suspected (Attachment I) or when an individual is undergoing long term treatment (greater than 30 days) with a high risk medication. The medical record must clearly document the specific condition or the high risk medication.

Visual examination with refraction (CPT 92015) is considered medically necessary and a covered medical benefit only in the treatment of 379.31 and Keratoconus 371.60 – 371.62 and for specific eye injuries 871.0 – 871.9, 921.0 – 921.9, 940.0 – 940.9, 950.0 – 950.9.

Analysis of the retinal nerve fiber layer in the diagnosis and evaluation of patients with glaucoma is a covered medical benefit (see Attachment IV for a list of covered diagnoses). 92133-Scanning computerized ophthalmic diagnostic imaging, posterior segment, unilateral or bilateral; 92134-Scanning computerized ophthalmic diagnostic imaging, posterior segment, unilateral or bilateral;

Scanning computerized opthalmic diagnostic imaging (SCODI) may be accomplished by various devices, among them Optical Coherence Tomography (OCT).

When used in diagnosing and monitoring glaucoma, nerve fiber layer, and optic nerve conditions, OCT testing may be allowed every year. If the testing is done more frequently than every year, the testing may be subject to review for medical necessity.

Retinal nerve fiber analysis is considered investigational as a screening tool for glaucoma in individuals who are not at high risk for glaucoma and for all other diagnoses not listed in Attachment IV. Techniques used in the analysis of the retinal nerve fiber layer include: • Scanning Laser Ophthalmoscopy (SLO) • Scanning Laser Polarimetry, and • Optical Coherence Tomography (OCT)

Optical coherence tomography (OCT) is a high resolution method of imaging the ocular structures. OCT for the anterior eye segment is being evaluated as a rapid and non-invasive diagnostic and screening tool for the detection of angle closure glaucoma. The Plan will not provide coverage for scanning computerized ophthalmic (e.g. OCT) imaging of the anterior eye segment because it is considered investigational . (92132)

Non-computer-assisted corneal topography is considered part of the evaluation/and management services of general ophthalmological services (CPT codes 92002–92014) and reimbursement for Plan contracted providers is set accordingly. Separate reimbursement is not appropriate for this procedure.

Computer-assisted corneal topography (CPT 92025) is considered not medically necessary to detect or monitor diseases of the .

Prescription glasses and contact lenses are covered only with (and subject to the limitations of) a vision materials rider except for Aphakia or Keratoconus.

Fundus photography (CPT 92250) is covered .

Therapeutic keratotomy (66999, S0812) is a covered medical benefit for recurrent erosion of the cornea (371.42) and anterior corneal dystrophies (371.52).

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When service or procedure may not be covered

Routine eye exams are not covered for any condition not listed on the covered diagnosis list (Attachment I), including for confirmation of defective vision identified on a covered screening examination, unless the member’s contract specifies they have the vision care benefit.

Any routine eye examinations or corrective eye wear required by an employer as a condition of employment is not covered.

Visual, training, eye exercises, orthoptics or plano (nonprescription) lenses are not covered. (CPT 92065)

Refraction (CPT 92015) is not covered unless the diagnosis is (Aphakia) 379.31 or (Keratoconus) 371.60 – 371.62, or (eye injuries) 871.0 – 871.9, 921.0 – 921.9, 940.0 – 940.9, 950.0 – 950.9.

Contact lenses and eyeglasses are not covered unless the member has a vision materials rider or to treat 379.31 (Aphakia) and 371.60-371.62 (Keratoconus). For Aphakia and Keratoconus, benefits for one set of eyeglasses or contact lenses for the original evaluation and one set for each new prescription will be provided when the diagnosis is 379.31 or 371.60-371.62.

Glaucoma Pressure Tests (CPT codes 92100, 92120, 92130, 92140, 92136) are not covered unless billed with a diagnosis from Attachment I.

A screening test for defective vision in conjunction with an evaluation and management service other than with a preventive medicine service done in accordance with current American Academy of Pediatrics, American Academy of Family Practice, and/or Bright Futures guidelines by a physician, physician assistant, or advanced practice nurse clinician is considered inclusive to the office visit or preventive medicine service, and separate reimbursement is not authorized.

The measurement of pulsatile ocular blood flow or blood flow velocity with Doppler ultrasonography is considered investigational in the diagnosis and follow-up of patients with glaucoma, and is therefore not covered.

New technology intraocular lenses are considered investigational as long term safety and efficacy is unproven and not medically necessary as standard lenses are available to provide normal vision.

Refractive Keratoplasty is a generic term, which includes all surgical procedures on the cornea to improve vision by changing the refractive index of the corneal surface.

Refractive keratoplasty procedures (CPT codes 65760, 65765, 65767, and 65771) are excluded under all certificates.

• Radial Keratotomy (RK) • Photorefractive Keratectomy (PRK) • Automated Lamellar Keratoplasty (ALK) • Minimally Invasive Radial Keratotomy (mini-RK) • Hexagonal Keratotomy • Keratomileusis • Keratophakia • Epikeratophakia (lamellar Keratoplasty)

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Billing and Coding/Physician Documentation Information

See Attachments I, II, III, and IV

Eligible Providers

Allopathic Physicians (M.D.) Osteopathic Physicians (D.O) Naturopathic Physicians (N.D) Advanced Practice Nurse Clinician (APRN) Optometrists (O.D.)

Policy Implementation/Update information

05/2003 clarified managed care and indemnity benefit 01/2003 Updated to address CPT codes 92250 and 92135 Supersedes policy/procedure Memo 86-35 and 86-36 Updated 11/2002 to reflect current codes, added 92250 to coverage list Updated to include benefits for CPT 92135 and additional covered diagnoses for refraction benefits Updated 04/2006 to clarify vision services as a medical benefit and to include additional CPT and diagnosis codes. Input received from BCBSVT Network ophthalmologists including Michelle Young, M.D.; Juli Larson, M.D.; David Lawlor, M.D.; Gordon Kelly, M.D.; Alan Irwin, M.D.; Robert Millay, M.D.; and Christopher Chapman, M.D. 02/2007 Annual review, minor diagnosis code additions. To be reviewed by the CAC 3/08 11/2009 Addition of benefits for vision screening during a preventive medicine service when done in accordance with national guidelines; new technology intraocular lenses added to appendix as not covered. 01/2011 Annual review, clarified OCT eligible diagnoses codes. Added new language relating to vision service coverage in standard contracts.

Approved by BCBSVT Medical Policy Committee: Date Approved

Antonietta Sculimbrene, M.D. Chair, Medical Policy Committee

Attachment I Covered Diagnoses List

Med ICD- Coding Notes Description Policy 9 Notes 053.20 Herpes zoster dermatitis of

4 053.21 Herpes zoster 053.22 Herpes zoster iridocyclitis Other ophthalmic herpes zoster 053.29 complications Unspecified ophthalmic complication herpes 054.40 simplex 054.41 Herpes simplex dermatitis of eyelid 054.42 Dendritic 054.43 Herpes simplex disciform keratitis 054.44 Herpes simplex iridocyclitis Herpes simplex with other ophthalmic 054.49 complications 077.0 Inclusion 077.1 Epidemic keratoconjunctivitis 077.2 Pharyngoconjunctival fever 077.3 Other adenoviral conjunctivitis 077.4 Epidemic hemorrhagic conjunctivitis 077.8 Other viral conjunctivitis Unspecified diseases of due to 077.98 Chlamydiae Unspecified diseases of conjunctiva due to 077.99 viruses Malignant melanoma of skin of eyelid, 172.1 including canthus Other malignant neoplasm of skin of eyelid, 173.1 including canthus Malignant neoplasm of eyeball, except 190.0 conjunctiva, cornea, retina, & 190.1 Malignant neoplasm of 190.2 Malignant neoplasm of lacrimal gland 190.3 Malignant neoplasm of conjunctiva 190.4 Malignant neoplasm of cornea 190.5 Malignant neoplasm of retina 190.6 Malignant neoplasm of choroid 190.7 Malignant neoplasm of lacrimal duct Malignant neoplasm of other specified sites 190.8 of eye 190.9 Malignant neoplasm of eye, part unspecified 216.1 Benign neoplasm of eyelid, including canthus Benign neoplasm of eyeball, except 224.0 conjunctiva, cornea, retina, & choroid 224.1 Benign neoplasm of orbit 224.2 Benign neoplasm of lacrimal gland 224.3 Benign neoplasm of conjunctiva 224.4 Benign neoplasm of cornea 224.5 Benign neoplasm of retina 224.6 Benign neoplasm of choroid 224.7 Benign neoplasm of lacrimal duct Benign neoplasm of other specified parts of 224.8 eye 224.9 Benign neoplasm of eye, part unspecified Benign neoplasm of pituitary gland and 227.3 craniopharyngeal duct (pouch) 228.03 Hemangioma of retina 234.0 Carcinoma in situ of eye

5 Neoplasms of unspecified nature; Other 239.81 specified sites, Retina and choroid Toxic diffuse goiter without mention of 242.00 Graves can be either code 242.01 thyrotoxicosis (Graves) Secondary diabetes mellitus without mention Use additional code to identify any 249.00 of complication, not stated as uncontrolled, or associated insulin use (V58.67) unspecified Use additional code to identify any Secondary diabetes mellitus without mention 249.01 associated insulin use (V58.67) of complication, uncontrolled Secondary diabetes mellitus with Use additional code to identify any ketoacidosis, not stated as uncontrolled, or 249.10 associated insulin use (V58.67) unspecified

Use additional code to identify any Secondary diabetes mellitus with 249.11 associated insulin use (V58.67) ketoacidosis, uncontrolled Secondary diabetes mellitus with Use additional code to identify any 249.20 hyperosmolarity, not stated as uncontrolled, associated insulin use (V58.67) or unspecified Use additional code to identify any Secondary diabetes mellitus with 249.21 associated insulin use (V58.67) hyperosmolarity, uncontrolled Use additional code to identify any Secondary diabetes mellitus with other coma, 249.30 associated insulin use (V58.67) not stated as uncontrolled, or unspecified Use additional code to identify any Secondary diabetes mellitus with other coma, 249.31 associated insulin use (V58.67) uncontrolled

Use additional code to identify any associated insulin use (V58.67); Use additional code to identify manifestation, Secondary diabetes mellitus with renal as: chronic kidney disease (585.1-585.9), 249.40 manifestations, not stated as uncontrolled, or diabetic nephropathy NOS (583.81), unspecified diabetic nephrosis (581.81), intercapillary glomerulosclerosis (581.81), Kimmelstiel- Wilson syndrome (581.81)

Use additional code to identify any associated insulin use (V58.67); Use additional code to identify manifestation, as: chronic kidney disease (585.1-585.9), Secondary diabetes mellitus with renal 249.41 diabetic nephropathy NOS (583.81), manifestations, uncontrolled diabetic nephrosis (581.81), intercapillary glomerulosclerosis (581.81), Kimmelstiel- Wilson syndrome (581.81)

Use additional code to identify any associated insulin use (V58.67); Use additional code to identify manifestation, as: diabetic blindness (369.00-369.9), Secondary diabetes mellitus with ophthalmic 249.50 diabetic (366.41), diabetic manifestations, not stated as uncontrolled, or glaucoma (365.44), diabetic macular unspecified edema (362.07), diabetic retinal edema (362.07), (362.01- 362.07)

6 Use additional code to identify any associated insulin use (V58.67); Use additional code to identify manifestation, as: diabetic blindness (369.00-369.9), Secondary diabetes mellitus with ophthalmic 249.51 diabetic cataract (366.41), diabetic manifestations, uncontrolled glaucoma (365.44), diabetic (362.07), diabetic retinal edema (362.07), diabetic retinopathy (362.01- 362.07)

Use additional code to identify any associated insulin use (V58.67); Use additional code to identify manifestation, as: diabetic amyotrophy (353.5), diabetic Secondary diabetes mellitus with neurological gastroparalysis (536.3), diabetic 249.60 manifestations, not stated as uncontrolled, or gastroparesis (536.3) , diabetic unspecified mononeuropathy (354.0-355.9), diabetic neurogenic arthropathy (713.5), diabetic peripheral autonomic neuropathy (337.1), diabetic polyneuropathy (357.2)

Use additional code to identify any associated insulin use (V58.67); Use additional code to identify manifestation, as: diabetic amyotrophy (353.5), diabetic gastroparalysis (536.3), diabetic Secondary diabetes mellitus with neurological 249.61 gastroparesis (536.3) , diabetic manifestations, uncontrolled mononeuropathy (354.0-355.9), diabetic neurogenic arthropathy (713.5), diabetic peripheral autonomic neuropathy (337.1), diabetic polyneuropathy (357.2)

Use additional code to identify any associated insulin use (V58.67); Use Secondary diabetes mellitus with peripheral 249.70 additional code to identify manifestation, circulatory disorders, not stated as as: diabetic gangrene (785.4), diabetic uncontrolled, or unspecified peripheral angiopathy (443.81)

Use additional code to identify any associated insulin use (V58.67); Use Secondary diabetes mellitus with peripheral 249.71 additional code to identify manifestation, circulatory disorders, uncontrolled as: diabetic gangrene (785.4), diabetic peripheral angiopathy (443.81)

Use additional code to identify any associated insulin use (V58.67); Use Secondary diabetes mellitus with other 249.80 additional code to identify manifestation, specified manifestations, not stated as as: any associated ulceration (707.10- uncontrolled, or unspecified 707.9), diabetic bone changes (731.8)

Use additional code to identify any associated insulin use (V58.67); Use Secondary diabetes mellitus with other 249.81 additional code to identify manifestation, specified manifestations, uncontrolled as: any associated ulceration (707.10- 707.9), diabetic bone changes (731.8)

Secondary diabetes mellitus with unspecified Use additional code to identify any 249.90 complication, not stated as uncontrolled, or associated insulin use (V58.67); unspecified Use additional code to identify any Secondary diabetes mellitus with unspecified 249.91 associated insulin use (V58.67); complication, uncontrolled Use additional code if applicable, for Diabetes mellitus without mention of 250.00 associated long-term (current) insulin use complication, type II or unspecified type, not (V58.67) stated as uncontrolled

7 Diabetes mellitus without mention of 250.01 complication, type I [juvenile type], not stated as uncontrolled Use additional code, if applicable, for Diabetes mellitus without mention of 250.02 associated, for long-term (current), insulin complication, type II or unspecified type, use (V58.67) uncontrolled Diabetes mellitus without mention of 250.03 complication, type I [juvenile type], uncontrolled Use additional code, if applicable, for Diabetes with ketoacidosis, type II or 250.10 associated long-term (current) insulin use unspecified type, not stated as uncontrolled (V58.67) Diabetes with ketoacidosis, type I [juvenile 250.11 type], not stated as uncontrolled Use additional code, if applicable for Diabetes with ketoacidosis, type II or 250.12 associated long-term (current) insulin use unspecified type, uncontrolled (V58.67) Diabetes with ketoacidosis, type I [juvenile 250.13 type], uncontrolled Use additional code, if applicable for Diabetes with hyperosmolarity, type II or 250.20 associated long-term (current) insulin use unspecified type, not stated as uncontrolled (V58.67) Diabetes with hyperosmolarity, type I 250.21 [juvenile type], not stated as uncontrolled Use additional code, if applicable for Diabetes with hyperosmolarity, type II or 250.22 associated long-term (current) insulin use unspecified type, uncontrolled Diabetes with hyperosmolarity, type I 250.23 [juvenile type], uncontrolled Use additional code, if applicable for Diabetes with other coma, type II or 250.30 associated long-term (current) insulin use unspecified type, not stated as uncontrolled (V58.67) Diabetes with other coma, type I [juvenile 250.31 type], not stated as uncontrolled Use additional code, if applicable for Diabetes with other coma, type II or 250.32 associated long-term (current) insulin use unspecified type, uncontrolled (V58.67) Diabetes with other coma, type I [juvenile 250.33 type], uncontrolled

Use additional code to identify manifestation as: chronic kidney disease- 585.1585.9, diabetic neuropathy NOS 583.81, Nephrosis, intercapilluary Diabetes with renal manifestations, type II or 250.40 glanularoma, Kimmelstiel-Wilson syndrome unspecified type, not stated as uncontrolled 581.81, Use additional code, if applicable for associated long-term (current) insulin use (V58.67)

Use additional code to identify manifestation as: chronic kidney disease- 585.1585.9, diabetic neuropathy NOS Diabetes with renal manifestations, type I 250.41 583.81, Nephrosis, intercapilluary [juvenile type], not stated as uncontrolled glanularoma, Kimmelstiel-Wilson syndrome 581.81,

8 Use additional code to identify manifestation as: chronic kidney disease- 585.1585.9, diabetic neuropathy NOS 583.81, Nephrosis, intercapilluary Diabetes with renal manifestations, type II or 250.42 glanularoma, Kimmelstiel-Wilson syndrome unspecified type, uncontrolled 581.81, Use additional code, if applicable for associated long-term (current) insulin use (V58.67)

Use additional code to identify manifestation as: chronic kidney disease- 585.1585.9, diabetic neuropathy NOS Diabetes with renal manifestations, type I 250.43 583.81, Nephrosis, intercapilluary [juvenile type], uncontrolled glanularoma, Kimmelstiel-Wilson syndrome 581.81,

Use additional code to identify manifestation, as: diabetic: blindness Diabetes with ophthalmic manifestations, (369.00-369.9), cataract (366.41), 250.50 type II or unspecified type, not stated as glaucoma (365.44), macular edema uncontrolled (362.07), retinal edema (362.07), retinopathy (362.01-362.07)

Use additional code to identify manifestation, as: diabetic: blindness Diabetes with ophthalmic manifestations, (369.00-369.9), cataract (366.41), 250.51 type I [juvenile type], not stated as glaucoma (365.44), macular edema uncontrolled (362.07), retinal edema (362.07), retinopathy (362.01-362.07)

Use additional code to identify manifestation, as: diabetic: blindness (369.00-369.9), cataract (366.41), Diabetes with ophthalmic manifestations, 250.52 glaucoma (365.44), macular edema type II or unspecified type, uncontrolled (362.07), retinal edema (362.07), retinopathy (362.01-362.07)

Use additional code to identify manifestation, as: diabetic: blindness (369.00-369.9), cataract (366.41), Diabetes with ophthalmic manifestations, 250.53 glaucoma (365.44), macular edema type I [juvenile type], uncontrolled (362.07), retinal edema (362.07), retinopathy (362.01-362.07)

Use additional code to identify manifestation, as: diabetic: amyotrophy (353.5) Diabetes with neurological manifestations, gastroparalysis (536.3), gastroparesis 250.60 type II or unspecified type, not stated as (536.3), mononeuropathy (354.0-355.9), uncontrolled neurogenic arthropathy (713.5),peripheral autonomic neuropathy (337.1), polyneuropathy (357.2)

Use additional code to identify manifestation, as: diabetic: amyotrophy (353.5) Diabetes with neurological manifestations, gastroparalysis (536.3), gastroparesis 250.61 type I [juvenile type], not stated as (536.3), mononeuropathy (354.0-355.9), uncontrolled neurogenic arthropathy (713.5),peripheral autonomic neuropathy (337.1), polyneuropathy (357.2)

9 Use additional code to identify manifestation, as: diabetic: amyotrophy (353.5) gastroparalysis (536.3), gastroparesis Diabetes with neurological manifestations, 250.62 (536.3), mononeuropathy (354.0-355.9), type II or unspecified type, uncontrolled neurogenic arthropathy (713.5),peripheral autonomic neuropathy (337.1), polyneuropathy (357.2)

Use additional code to identify manifestation, as: diabetic: amyotrophy (353.5) gastroparalysis (536.3), gastroparesis Diabetes with neurological manifestations, 250.63 (536.3), mononeuropathy (354.0-355.9), type I [juvenile type], uncontrolled neurogenic arthropathy (713.5),peripheral autonomic neuropathy (337.1), polyneuropathy (357.2)

Use additional code to identify manifestation, as: diabetic: gangrene Diabetes with peripheral circulatory disorders, (785.4) peripheral angiopathy (443.81) 250.70 type II or unspecified type, not stated as Use additional code, if applicable for uncontrolled associated long-term (current) insulin use (V58.67)

Use additional code to identify Diabetes with peripheral circulatory disorders, 250.71 manifestation, as: diabetic: gangrene type I [juvenile type], not stated as (785.4) peripheral angiopathy (443.81) uncontrolled

Use additional code to identify manifestation, as: diabetic: gangrene (785.4) peripheral angiopathy (443.81) Diabetes with peripheral circulatory disorders, 250.72 Use additional code, if applicable for type II or unspecified type, uncontrolled associated long-term (current) insulin use (V58.67)

Use additional code to identify Diabetes with peripheral circulatory disorders, 250.73 manifestation, as: diabetic: gangrene type I [juvenile type], uncontrolled (785.4) peripheral angiopathy (443.81)

Use additional code to identify manifestation, as: any associated Diabetes with other specified manifestations, ulceration (707.10-707.9) diabetic bone 250.80 type II or unspecified type, not stated as changes (731.8) Use additional code, if uncontrolled applicable for associated long-term (current) insulin use (V58.67)

Use additional code to identify Diabetes with other specified manifestations, manifestation, as: any associated 250.81 type I [juvenile type], not stated as ulceration (707.10-707.9) diabetic bone uncontrolled changes (731.8)

Use additional code to identify manifestation, as: any associated ulceration (707.10-707.9) diabetic bone Diabetes with other specified manifestations, 250.82 changes (731.8) Use additional code, if type II or unspecified type, uncontrolled applicable for associated long-term (current) insulin use (V58.67)

Use additional code to identify manifestation, as: any associated Diabetes with other specified manifestations, 250.83 ulceration (707.10-707.9) diabetic bone type I [juvenile type], uncontrolled changes (731.8)

Use additional code, if applicable for Diabetes with unspecified complication, type 250.90 associated long-term (current) insulin use II or unspecified type, not stated as (V58.67) uncontrolled

10 Use additional code, if applicable for Diabetes with unspecified complication, type I 250.91 associated long-term (current) insulin use [juvenile type], not stated as uncontrolled (V58.67) Use additional code, if applicable for Diabetes with unspecified complication, type 250.92 associated long-term (current) insulin use II or unspecified type, uncontrolled (V58.67) Use additional code, if applicable for Diabetes with unspecified complication, type I 250.93 associated long-term (current) insulin use [juvenile type], uncontrolled (V58.67) Use additional E code to identify cause, if 251.0 Hypoglycemic coma drug-induced Use additional E code to identify cause, if 251.1 Other specified hypoglycemia drug-induced 251.2 Hypoglycemia, unspecified Use additional code to identify (any associated): acquired absence of 251.3 pancreas (V88.11-V88.12), insulin use Postsurgical hypoinsulinemia (V58.67), secondary diabetes mellitus (249.00-249.91)

251.4 Abnormality of secretion of glucagon

251.5 Abnormality of secretion of gastrin Other specified disorders of pancreatic 251.8 internal secretion

Unspecified disorder of pancreatic internal 251.9 secretion

Other disturbances of aromatic amino-acid 270.2 metabolism 340 Multiple sclerosis 341.0 Neuromyelitis optica 341.1 Schilder's disease 341.20 Acute (transverse) myelitis NOS Acute (transverse) myelitis in conditions 341.21 classified elsewhere 341.22 Idiopathic transverse myelitis Other demyelinating diseases of central 341.8 nervous system Demyelinating disease of central nervous 341.9 system, unspecified Other forms of migraine, without mention of 346.80 intractable migraine without mention of status migrainosus 351.0 Bell's palsy 351.1 Geniculate ganglionitis 351.8 Other facial nerve disorders 351.9 Unspecified facial nerve disorder 360.00 Purulent , unspecified 360.01 Acute endophthalmitis 360.02 Panophthalmitis 360.03 Chronic endophthalmitis 360.04 Vitreous abscess 360.11 Sympathetic 360.12 Panuveitis 360.13 Parasitic endophthalmitis NOS 360.14 Ophthalmia nodosa

11 360.19 Other endophthalmitis 360.20 Unspecified degenerative disorder of 360.21 Progressive high (degenerative) myopia 360.23 Siderosis of globe 360.24 Other metallosis of globe 360.29 Other degenerative disorders of globe 360.30 Unspecified hypotony of eye 360.31 Primary hypotony of eye 360.32 Ocular fistula causing hypotony Hypotony associated with other ocular 360.33 disorders 360.34 Flat anterior chamber of eye 360.40 Unspecified degenerated globe or eye 360.41 Blind hypotensive eye 360.42 Blind hypertensive eye 360.43 Hemophthalmos, except current injury 360.44 Leucocoria Use additional code to identify foreign body Foreign body, magnetic, intraocular, 360.50 (V90.11) unspecified Use additional code to identify foreign body 360.51 Foreign body, magnetic, in anterior chamber (V90.11) Use additional code to identify foreign body 360.52 Foreign body, magnetic, in or (V90.11) Use additional code to identify foreign body 360.53 Foreign body, magnetic, in (V90.11) Use additional code to identify foreign body 360.54 Foreign body, magnetic, in vitreous (V90.11) Use additional code to identify foreign body 360.55 Foreign body, magnetic, in posterior wall (V90.11) Use additional code to identify foreign body Foreign body, magnetic, in other or multiple 360.59 (V90.11) sites Use additional code to identify foreign body 360.60 Foreign body, intraocular, unspecified (V90.01-V90.10, V90.2-V90.9, V90.12) Use additional code to identify foreign body 360.61 Foreign body in anterior chamber (V90.01-V90.10, V90.2-V90.9, V90.12) Use additional code to identify foreign body 360.62 Foreign body in iris or ciliary body (V90.01-V90.10, V90.2-V90.9, V90.12) Use additional code to identify foreign body 360.63 Foreign body in lens (V90.01-V90.10, V90.2-V90.9, V90.12) Use additional code to identify foreign body 360.64 Foreign body in vitreous (V90.01-V90.10, V90.2-V90.9, V90.12) Use additional code to identify foreign body 360.65 Foreign body in posterior wall of eye (V90.01-V90.10, V90.2-V90.9, V90.12) Use additional code to identify foreign body 360.69 Foreign body in other or multiple sites of eye (V90.01-V90.10, V90.2-V90.9, V90.12) 360.81 Luxation of globe 360.89 Other disorders of globe 360.9 Unspecified disorder of globe with retinal defect, 361.00 unspecified 361.01 Recent detachment, partial, with single defect Recent detachment, partial, with multiple 361.02 defects 361.03 Recent detachment, partial, with giant tear

12 Recent detachment, partial, with retinal 361.04 dialysis 361.05 Recent detachment, total or subtotal 361.06 Old detachment, partial 361.07 Old detachment, total or subtotal 361.10 Unspecified 361.11 Flat retinoschisis 361.12 Bullous retinoschisis 361.13 Primary retinal cysts 361.14 Secondary retinal cysts Other retinoschisis and retinal cysts 361.19 (Pseudocyst of retina) 361.2 Serous retinal detachment 361.30 Unspecified retinal defect (Retinal Break) 361.31 Round hole of retina without detachment 361.32 Horseshoe tear of retina without detachment 361.33 Multiple defects of retina without detachment 361.81 Traction detachment of retina 361.89 Other forms of retinal detachment 361.9 Unspecified retinal detachment 362.01 Code first diabetes (249.5, 250.5) Background diabetic retinopathy (BDR) 362.02 Code first diabetes (249.5, 250.5) Proliferative diabetic retinopathy (PDR) Nonproliferative diabetic retinopathy NOS 362.03 Code first diabetes (249.5, 250.5) (NPDR) 362.04 Code first diabetes (249.5, 250.5) Mild nonproliferative diabetic retinopathy Moderate nonproliferative diabetic 362.05 Code first diabetes (249.5, 250.5) retinopathy 362.06 Code first diabetes (249.5, 250.5) Severe nonproliferative diabetic retinopathy Code 362.07 must be used with a code for diabetic retinopathy (362.01-362.06) 362.07 Diabetic macular edema *****Also Code first diabetes (249.5, 250.5) prior to 362.01-362.06 codes***** 362.10 Background retinopathy, unspecified

Hypertensive Retinopathy: Two codes are necessary to identify the condition. First assign the code from subcategory 362.11, 362.11 Hypertensive retinopathy, then the appropriate code from categories 401-405 to indicate the type of hypertension.

362.12 Exudative retinopathy Use additional code for any associated 362.13 Changes in vascular appearance of retina atherosclerosis (440.8) 362.14 Retinal microaneurysms NOS 362.15 Retinal telangiectasia 362.16 Retinal neovascularization NOS 362.17 Other intraretinal microvascular abnormalities 362.18 Retinal vasculitis 362.20 Retinopathy of prematurity, unspecified 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

13 362.30 Unspecified retinal vascular occlusion 362.31 Central retinal artery occlusion (CRAO) 362.32 Arterial branch occlusion 362.33 Partial arterial occlusion 362.34 Transient arterial occlusion of retina 362.35 Central retinal vein occlusion (CRVO) 362.36 Venous tributary (branch) occlusion (BRVO) 362.37 Venous engorgement of retina 362.40 Retinal layer separation, unspecified 362.41 Central serous retinopathy Serous detachment of retinal pigment 362.42 epithelium (RPE) Hemorrhagic detachment of retinal pigment 362.43 epithelium 362.50 Macular degeneration (senile), unspecified 362.51 Nonexudative senile macular degeneration 362.52 Exudative senile macular degeneration 362.53 Cystoid macular degeneration 362.54 Macular cyst, hole, or pseudohole of retina 362.55 Toxic of retina 362.56 Macular puckering of retina (ERM) 362.57 Drusen (degenerative) of retina 362.60 Unspecified peripheral retinal degeneration Paving stone degeneration of peripheral 362.61 retina Microcystoid degeneration of peripheral 362.62 retina 362.63 Lattice degeneration of peripheral retina Senile reticular degeneration of peripheral 362.64 retina Secondary pigmentary degeneration of 362.65 peripheral retina 362.66 Secondary vitreoretinal degenerations 362.70 Unspecified hereditary retinal dystrophy Code first underlying disease, as: Retinal dystrophy in systemic or 362.71 cerebroretinal lipidoses (330.1) systemic cerebroretinal lipidoses lipidoses (272.7) Code first underlying disease, as: Bassen- Retinal dystrophy in other systemic disorders 362.72 Kornzweig syndrome (272.5), Refsum's and syndromes disease (356.3) 362.73 Vitreoretinal dystrophies 362.74 Pigmentary retinal dystrophy Other dystrophies primarily involving the 362.75 sensory retina Dystrophies primarily involving the retinal 362.76 pigment epithelium Dystrophies primarily involving Bruch's 362.77 membrane 362.81 Retinal hemorrhage 362.82 Retinal exudates and deposits 362.83 Retinal edema 362.84 Retinal ischemia 362.85 Retinal nerve fiber bundle defects 362.89 Other retinal disorders 362.9 Unspecified retinal disorder

14 363.00 Focal , unspecified Focal choroiditis and chorioretinitis, 363.01 juxtapapillary Focal choroiditis and chorioretinitis of other 363.03 posterior pole Focal choroiditis and chorioretinitis, 363.04 peripheral Focal and retinochoroiditis, 363.05 juxtapapillary Focal retinitis and retinochoroiditis, macular 363.06 or paramacular Focal retinitis and retinochoroiditis of other 363.07 posterior pole 363.08 Focal retinitis and retinochoroiditis, peripheral 363.10 Disseminated chorioretinitis, unspecified Disseminated choroiditis and chorioretinitis, 363.11 posterior pole Disseminated choroiditis and chorioretinitis, 363.12 peripheral Code first any underlying disease, as: Disseminated choroiditis and chorioretinitis, 363.13 tuberculosis (017.3) generalized Disseminated retinitis and retinochoroiditis, 363.14 metastatic Disseminated retinitis and retinochoroiditis, 363.15 pigment epitheliopathy 363.20 Unspecified chorioretinitis 363.21 Pars planitis 363.22 Harada's disease 363.30 Unspecified chorioretinal scar 363.31 Solar retinopathy 363.32 Other macular scars 363.33 Other scars of posterior pole 363.34 Peripheral scars 363.35 Disseminated scars 363.40 Unspecified choroidal degeneration 363.41 Senile atrophy of choroid 363.42 Diffuse secondary atrophy of choroid 363.43 Angioid streaks of choroid Hereditary choroidal dystrophy or atrophy, 363.50 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

363.56 Other diffuse or generalized dystrophy, partial

363.57 Other diffuse or generalized dystrophy, total 363.61 Unspecified choroidal hemorrhage 363.62 Expulsive choroidal hemorrhage 363.63 Choroidal rupture 363.70 Unspecified choroidal detachment 363.71 Serous choroidal detachment 363.72 Hemorrhagic choroidal detachment 363.8 Other disorders of choroid 363.9 Unspecified disorder of choroid

15 364.00 Unspecified acute and subacute iridocyclitis 364.01 Primary iridocyclitis 364.02 Recurrent iridocyclitis 364.03 Secondary iridocyclitis, infectious 364.04 Secondary iridocyclitis, noninfectious 364.05 364.10 Unspecified chronic iridocyclitis Code first underlying disease, as: Chronic iridocyclitis in diseases classified 364.11 Sarcoidosis (135), Tuberculosis (017.3) elsewhere 364.21 Fuchs' heterochromic cyclitis 364.22 Glaucomatocyclitic crises 364.23 Lens-induced iridocyclitis 364.24 Vogt-Koyanagi syndrome 364.3 Unspecified iridocyclitis 364.41 364.42 364.51 Essential or progressive iris atrophy 364.52 Iridoschisis 364.53 Pigmentary iris degeneration 364.54 Degeneration of pupillary margin 364.55 Miotic cysts of pupillary margin 364.56 Degenerative changes of chamber angle 364.57 Degenerative changes of ciliary body 364.59 Other iris atrophy 364.60 Idiopathic cysts 364.61 Implantation cysts 364.62 Exudative cysts of iris or anterior chamber 364.63 Primary cyst of pars plana 364.64 Exudative cyst of pars plana 364.70 Unspecified adhesions of iris 364.71 Posterior synechiae 364.72 Anterior synechiae 364.73 Goniosynechiae 364.74 Pupillary membranes 364.75 Pupillary abnormalities 364.76 364.77 Recession of chamber angle of eye 364.81 Floppy iris syndrome (IFIS) 364.82 Plateau iris syndrome 364.89 Other disorders of iris and ciliary body 364.9 Unspecified disorder of iris and ciliary body 365.00 Preglaucoma, unspecified 365.01 Open angle with borderline findings 365.02 Anatomical narrow angle 365.03 Steroid responders 365.04 365.10 Unspecified open-angle glaucoma Primary open-angle glaucoma (POAG or 365.11 COAG) 365.12 Low tension open-angle glaucoma 365.13 Pigmentary open-angle glaucoma 365.14 Open-angle glaucoma of childhood 365.15 Residual stage of open angle glaucoma 365.20 Primary angle-closure glaucoma, unspecified 365.21 Intermittent angle-closure glaucoma

16 365.22 Acute angle-closure glaucoma 365.23 Chronic angle-closure glaucoma 365.24 Residual stage of angle-closure glaucoma 365.31 Glaucomatous stage 365.32 Residual stage Glaucoma associated with chamber angle 365.41 anomalies 365.42 Glaucoma associated with anomalies of iris Glaucoma associated with other anterior 365.43 segment anomalies Code first associated disease, as Glaucoma associated with systemic 365.44 neurofibromatosis (237.70-237.79) syndromes Sturge-Weber (-Dimitri) syndrome (759.6), 365.51 Phacolytic glaucoma 365.52 Pseudoexfoliation glaucoma Glaucoma associated with other lens 365.59 disorders Glaucoma associated with unspecified ocular 365.60 disorder 365.61 Glaucoma associated with pupillary block Glaucoma associated with ocular 365.62 inflammations

365.63 Glaucoma associated with vascular disorders

365.64 Glaucoma associated with tumors or cysts 365.65 Glaucoma associated with ocular trauma 365.81 Hypersecretion glaucoma Glaucoma with increased episcleral venous 365.82 pressure 365.83 Aqueous misdirection 365.89 Other specified glaucoma 365.9 Unspecified glaucoma 366.00 Nonsenile cataract, unspecified Anterior subcapsular polar cataract, 366.01 nonsenile Posterior subcapsular polar cataract, 366.02 nonsenile 366.03 Cortical, lamellar, or zonular cataract 366.04 Nuclear cataract Other and combined forms of nonsenile 366.09 cataract 366.10 Unspecified senile cataract 366.11 Pseudoexfoliation of lens capsule 366.12 Incipient cataract 366.13 Anterior subcapsular polar senile cataract 366.14 Posterior subcapsular polar senile cataract 366.15 Cortical senile cataract 366.16 Nuclear sclerosis (NS) 366.17 Total or mature senile cataract 366.18 Hypermature senile cataract Other and combined forms of senile cataract 366.19 (Mixed) 366.20 Unspecified traumatic cataract 366.21 Localized traumatic opacities of cataract 366.22 Total traumatic cataract

17 366.23 Partially resolved traumatic cataract 366.30 Unspecified cataracta complicata Code first underlying glaucoma (365.0- 366.31 Glaucomatous flecks (subcapsular) 365.9) Code first underlying condition, as: 366.32 Cataract in inflammatory ocular disorders chronic choroiditis (363.0-363.2) Code first underlying condition, as: chronic 366.33 Cataract with ocular neovascularization iridocyclitis (364.10) Code first underlying condition, as: chalcosis (360.24) degenerative myopia 366.34 Cataract in degenerative ocular disorders (360.21) pigmentary retinal dystrophy (362.74) 366.41 Code first diabetes (249.5, 250.5) Diabetic cataract Code first underlying disease, as: 366.42 calcinosis (275.4) hypoparathyroidism Tetanic cataract (252.1) Code first underlying disorder (359.21- 366.43 Myotonic cataract 359.23) Code first underlying condition, as: 366.44 craniofacial dysostosis (756.0) Cataract associated with other syndromes galactosemia (271.1) Use additional E code to identify drug or 366.45 Toxic cataract other toxic substance Cataract associated with radiation and other 366.46 Use additional E code to identify cause physical influences 366.50 Unspecified after-cataract 366.51 Soemmering's ring 366.52 Other after-cataract, not obscuring vision 366.53 After-cataract, obscuring vision 366.8 Other cataract 366.9 Unspecified cataract 368.00 Amblyopia, unspecified 368.01 Strabismic amblyopia 368.02 Deprivation amblyopia 368.03 Refractive amblyopia 368.10 Subjective visual disturbance, unspecified 368.11 Sudden visual loss 368.12 Transient visual loss 368.13 Visual discomfort 368.14 Visual distortions of shape and size Other visual distortions and entoptic 368.15 phenomena 368.16 Psychophysical visual disturbances 368.2 368.30 Binocular , unspecified 368.31 Suppression of

368.32 Simultaneous visual perception without fusion

368.33 Fusion with defective stereopsis 368.34 Abnormal retinal correspondence 368.40 Visual field defect, unspecified 368.41 involving central area 368.42 Scotoma of blind spot area 368.43 Sector or arcuate defects 368.44 Other localized visual field defect

18 368.45 Generalized contraction or constriction 368.46 Homonymous bilateral field defects 368.47 Heteronymous bilateral field defects Blindness of both , impairment level not 369.00 further specified Better eye: total impairment; lesser eye: total 369.01 impairment Better eye: near-total impairment; lesser eye: 369.02 not further specified Better eye: near-total impairment; lesser eye: 369.03 total impairment Better eye: near-total impairment; lesser eye: 369.04 near-total impairment Better eye: profound impairment; lesser eye: 369.05 not further specified Better eye: profound impairment; lesser eye: 369.06 total impairment Better eye: profound impairment; lesser eye: 369.07 near-total impairment Better eye: profound impairment; lesser eye: 369.08 profound impairment 369.60 Impairment level not further specified One eye: total impairment; other eye: not 369.61 specified One eye: total impairment; other eye: near- 369.62 normal vision One eye: total impairment; other eye: normal 369.63 vision One eye: near-total impairment; other eye: 369.64 not specified One eye: near-total impairment; other eye: 369.65 near-normal vision One eye: near-total impairment; other eye: 369.66 normal vision One eye: profound impairment; other eye: not 369.67 specified One eye: profound impairment; other eye: 369.68 near-normal vision One eye: profound impairment; other eye: 369.69 normal vision 370.00 , unspecified 370.01 Marginal corneal ulcer 370.02 Ring corneal ulcer 370.03 Central corneal ulcer 370.04 Hypopyon ulcer 370.05 Mycotic corneal ulcer 370.06 Perforated corneal ulcer 370.07 Mooren's ulcer 370.20 Superficial keratitis, unspecified 370.21 Punctate keratitis (SPK) 370.22 Macular keratitis 370.23 Filamentary keratitis 370.24 Use additional code for any associated 370.31 Phlyctenular keratoconjunctivitis tuberculosis (017.3)

19 Use additional code for vernal conjunctivitis Limbar and corneal involvement in vernal 370.32 (372.13) conjunctivitis Keratoconjunctivitis sicca, not specified as 370.33 Sjogren's 370.34 Exposure keratoconjunctivitis 370.35 Neurotrophic keratoconjunctivitis 370.40 Keratoconjunctivitis, unspecified Code first underlying condition (050.0- 370.44 Keratitis or keratoconjunctivitis in exanthema 052.9) 370.49 Other unspecified keratoconjunctivitis 370.50 Interstitial keratitis, unspecified 370.52 Diffuse interstitial keratitis 370.54 Sclerosing keratitis 370.55 Corneal abscess 370.59 Other interstitial and deep keratitis 370.60 Corneal neovascularization, unspecified 370.61 Localized vascularization of cornea 370.62 Pannus (corneal) 370.63 Deep vascularization of cornea 370.64 Ghost vessels (corneal) Code first underlying condition, such as: 370.8 Other forms of keratitis Acanthamoeba (136.21), Fusarium (118) 370.9 Unspecified keratitis 371.00 , unspecified 371.01 Minor opacity of cornea 371.02 Peripheral opacity of cornea 371.03 Central opacity of cornea 371.03 Central opacity of cornea 371.04 Adherent leucoma 371.05 Code first underlying tuberculosis (017.3) Phthisical cornea 371.10 Corneal deposit, unspecified 371.11 Anterior pigmentations 371.12 Stromal pigmentations 371.13 Posterior pigmentations 371.14 Kayser-Fleischer ring Other deposits associated with metabolic 371.15 disorders 371.16 Argentous deposits 371.20 Corneal edema, unspecified 371.21 Idiopathic corneal edema 371.22 Secondary corneal edema 371.23 Bullous keratopathy Corneal edema due to wearing of contact 371.24 lenses 371.30 Corneal membrane change, unspecified 371.31 Folds and rupture of Bowman's membrane 371.32 Folds in Descemet's membrane 371.33 Rupture in Descemet's membrane 371.40 Corneal degeneration, unspecified 371.41 Senile corneal changes 371.42 Recurrent erosion of cornea 371.43 Band-shaped keratopathy 371.44 Other calcerous degenerations of cornea 371.45 Keratomalacia NOS 371.46 Nodular degeneration of cornea

20 371.48 Peripheral degenerations of cornea 371.49 Other corneal degenerations 371.50 , unspecified 371.51 Juvenile epithelial corneal dystrophy 371.52 Other anterior corneal dystrophies 371.53 Granular corneal dystrophy 371.54 Lattice corneal dystrophy 371.55 Macular corneal dystrophy 371.56 Other stromal corneal dystrophies 371.57 Endothelial corneal dystrophy 371.58 Other posterior corneal dystrophies 371.60 Keratoconus, unspecified 371.61 Keratoconus, stable condition 371.62 Keratoconus, acute hydrops 371.70 Corneal deformity, unspecified 371.71 Corneal ectasia 371.72 Descemetocele 371.73 Corneal staphyloma 371.81 Corneal anesthesia and hypoesthesia 371.82 Corneal disorder due to contact lens 371.89 Other corneal disorder 371.9 Unspecified corneal disorder 372.00 Acute conjunctivitis, unspecified 372.01 Serous conjunctivitis, except viral 372.02 Acute follicular conjunctivitis 372.03 Other mucopurulent conjunctivitis 372.04 Pseudomembranous conjunctivitis 372.05 Acute atopic conjunctivitis Use additional E code to identify the 372.06 Acute chemical conjunctivitis chemical or toxic agent 372.10 Chronic conjunctivitis, unspecified 372.11 Simple chronic conjunctivitis 372.12 Chronic follicular conjunctivitis 372.13 Vernal conjunctivitis 372.14 Other chronic Code first underlying disease, as: filariasis 372.15 (125.0-125.9) mucocutaneous Parasitic conjunctivitis leishmaniasis (085.5) 372.20 Blepharoconjunctivitis, unspecified 372.21 Angular blepharoconjunctivitis 372.22 Contact blepharoconjunctivitis 372.30 Unspecified conjunctivitis Code first underlying rosacea dermatitis 372.31 Rosacea conjunctivitis (695.3) Code first underlying disease, as: erythema 372.33 multiforme (695.10-695.19) Reiter's Conjunctivitis in mucocutaneous disease disease (099.3) 372.34 Pingueculitis 372.39 Other and unspecified conjunctivitis 372.40 , unspecified 372.41 Peripheral pterygium, stationary 372.42 Peripheral pterygium, progressive 372.43 Central pterygium 372.44 Double pterygium 372.45 Recurrent pterygium

21 372.50 Unspecified conjunctival degeneration 372.51 372.52 372.53 Conjunctival xerosis 372.54 Conjunctival concretions 372.55 Conjunctival pigmentations 372.56 Conjunctival deposits 372.61 Granuloma of conjunctiva Localized adhesions and strands of 372.62 conjunctiva 372.63 Symblepharon 372.64 Scarring of conjunctiva 372.71 Hyperemia of conjunctiva 372.72 Conjunctival hemorrhage (Subconjuctival) 372.73 Conjunctival edema 372.74 Vascular abnormalities of conjunctiva 372.75 Conjunctival cysts 372.81 372.89 Other disorders of conjunctiva 372.9 Unspecified disorder of conjunctiva 373.00 , unspecified 373.01 Ulcerative blepharitis 373.02 Squamous blepharitis 373.11 Hordeolum externum 373.12 Hordeolum internum 373.13 Abscess of eyelid 373.2 (Meibomiam gland cyst) 373.31 Eczematous dermatitis of eyelid 373.32 Contact and allergic dermatitis of eyelid 373.33 Xeroderma of eyelid 373.34 Discoid lupus erythematosus of eyelid Code first underlying disease as: leprosy Infective dermatitis of eyelid of types resulting 373.4 (030.0-030.9), lupus vulgaris (tuberculous) in deformity (017.0), yaws (102.0-102.9)

Code first underlying disease as: actinomycosis (039.3), impetigo (684), 373.5 Other infective dermatitis of eyelid mycotic dermatitis (110.0-111.9), vaccinia (051.0), post vaccination (999.0)

Code first underlying disease as: leishmaniasis (085.0-085.9), loiasis 373.6 Parasitic infestation of eyelid (125.2), (125.3), pediculosis (132.0) 373.8 Other inflammations of 373.9 Unspecified inflammation of eyelid 374.00 Unspecified 374.01 Senile entropion 374.02 Mechanical entropion 374.03 Spastic entropion 374.04 Cicatricial entropion 374.05 of eyelid without entropion 374.10 Unspecified 374.11 Senile ectropion 374.12 Mechanical ectropion 374.13 Spastic ectropion 374.14 Cicatricial ectropion

22 374.20 Unspecified 374.21 Paralytic lagophthalmos 374.22 Mechanical lagophthalmos 374.23 Cicatricial lagophthalmos 374.30 Unspecified of eyelid 374.31 Paralytic ptosis 374.32 Myogenic ptosis 374.33 Mechanical ptosis 374.34 374.41 Eyelid retraction or lag 374.43 Abnormal innervation syndrome of eyelid 374.44 Sensory disorders of eyelid 374.45 Other sensorimotor disorders of eyelid 374.46 374.50 Unspecified degenerative disorder of eyelid Code first underlying condition (272.0- 374.51 Xanthelasma of eyelid 272.9) 374.52 Hyperpigmentation of eyelid 374.53 Hypopigmentation of eyelid 374.54 Hypertrichosis of eyelid 374.55 Hypotrichosis of eyelid Other degenerative disorders of skin affecting 374.56 eyelid 374.81 Hemorrhage of eyelid 374.82 Edema of eyelid 374.83 Elephantiasis of eyelid 374.84 Cysts of eyelids 374.85 Vascular anomalies of eyelid Use additional code to identify foreign body 374.86 Retained foreign body of eyelid (v90.01-v90.9) 374.87 Dermatochalasis 374.89 Other disorders of eyelid 374.9 Unspecified disorder of eyelid 375.00 Unspecified 375.01 Acute dacryoadenitis 375.02 Chronic dacryoadenitis 375.03 Chronic enlargement of lacrimal gland 375.11 Dacryops 375.12 Other lacrimal cysts and cystic degeneration 375.13 Primary lacrimal atrophy 375.14 Secondary lacrimal atrophy 375.15 Unspecified tear film insufficiency (DES) 375.16 Dislocation of lacrimal gland 375.20 , unspecified as to cause 375.21 Epiphora due to excess lacrimation 375.22 Epiphora due to insufficient drainage 375.30 Unspecified 375.31 Acute canaliculitis, lacrimal 375.32 Acute dacryocystitis 375.33 Phlegmonous dacryocystitis 375.41 Chronic canaliculitis 375.42 Chronic dacryocystitis 375.43 Lacrimal mucocele 375.51 Eversion of lacrimal punctum 375.52 Stenosis of lacrimal punctum

23 375.53 Stenosis of lacrimal canaliculi 375.54 Stenosis of lacrimal sac 375.55 Obstruction of nasolacrimal duct, neonatal 375.56 Stenosis of nasolacrimal duct, acquired 375.57 Dacryolith 375.61 Lacrimal fistula 375.69 Other change of lacrimal passages 375.81 Granuloma of lacrimal passages 375.89 Other disorder of lacrimal system 375.9 Unspecified disorder of lacrimal system 376.00 Unspecified acute inflammation of orbit 376.01 376.02 Orbital periostitis 376.03 Orbital osteomyelitis 376.04 Orbital tenonitis 376.10 Unspecified chronic inflammation of orbit 376.11 Orbital granuloma 376.12 Orbital myositis Code first underlying disease, as: hydatid 376.13 infestation of orbit (122.3, 122.6, 122.9) Parasitic infestation of orbit myiasis of orbit (134.0) Code first underlying thyroid disorder 376.21 Thyrotoxic (242.0-242.9) Code first underlying thyroid disorder 376.22 Exophthalmic ophthalmoplegia (242.0-242.9) 376.30 Unspecified exophthalmos 376.31 Constant exophthalmos 376.32 Orbital hemorrhage 376.33 Orbital edema or congestion 376.34 Intermittent exophthalmos 376.35 Pulsating exophthalmos 376.36 Lateral displacement of globe of eye 376.40 Unspecified deformity of orbit 376.41 Hypertelorism of orbit 376.42 Exostosis of orbit 376.43 Local deformities due to bone disease Orbital deformities associated with 376.44 craniofacial deformities 376.45 Atrophy of orbit 376.46 Enlargement of orbit 376.47 Deformity of orbit due to trauma or surgery 376.50 , unspecified as to cause 376.51 Enophthalmos due to atrophy of orbital tissue 376.52 Enophthalmos due to trauma or surgery Use additional code to identify foreign body Retained (old) foreign body following 376.6 (V90.01-V90.9) penetrating wound of orbit 376.81 Orbital cysts 376.82 Myopathy of 376.89 Other orbital disorder 376.9 Unspecified disorder of orbit 377.00 Unspecified Papilledema associated with increased 377.01 intracranial pressure Papilledema associated with decreased 377.02 ocular pressure

24 377.03 Papilledema associated with retinal disorder 377.04 Foster-Kennedy syndrome 377.10 Optic atrophy, unspecified 377.10 Unspecified optic atrophy 377.11 Primary optic atrophy 377.12 Postinflammatory optic atrophy Optic atrophy associated with retinal 377.13 dystrophies 377.14 Glaucomatous atrophy (cupping) of 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 Unspecified 377.31 377.32 Retrobulbar neuritis (acute) 377.33 Nutritional 377.34 Toxic optic neuropathy 377.39 Other optic neuritis 377.41 Ischemic optic neuropathy 377.42 Hemorrhage in optic nerve sheaths 377.43 377.49 Other disorder of optic nerve Associated with pituitary neoplasms and 377.51 disorders 377.52 Associated with other neoplasms 377.53 Associated with vascular disorders 377.54 Associated with inflammatory disorders 377.61 Associated with neoplasms 377.62 Associated with vascular disorders 377.63 Associated with inflammatory disorders 377.71 Associated with neoplasms 377.72 Associated with vascular disorders 377.73 Associated with inflammatory disorders 377.75 Cortical blindness Unspecified disorder of optic nerve and visual 377.9 pathways 378.00 Unspecified 378.01 Monocular esotropia 378.02 Monocular esotropia with A pattern 378.03 Monocular esotropia with V pattern Monocular esotropia with other 378.04 noncomitancies 378.05 Alternating esotropia 378.06 Alternating esotropia with A pattern 378.07 Alternating esotropia with V pattern Alternating esotropia with other 378.08 noncomitancies 378.10 Unspecified 378.11 Monocular exotropia 378.12 Monocular exotropia with A pattern 378.13 Monocular exotropia with V pattern

25 Monocular exotropia with other 378.14 noncomitancies 378.15 Alternating exotropia 378.16 Alternating exotropia with A pattern 378.17 Alternating exotropia with V pattern Alternating exotropia with other 378.18 noncomitancies 378.20 Unspecified intermittent heterotropia 378.21 Intermittent esotropia, monocular 378.22 Intermittent esotropia, alternating 378.23 Intermittent exotropia, monocular 378.24 Intermittent exotropia, alternating 378.30 Unspecified heterotropia 378.31 378.32 Hypotropia 378.33 378.34 378.35 Accommodative component in esotropia 378.40 Unspecified 378.41 Esophoria 378.42 378.43 Vertical heterophoria 378.44 Cyclophoria 378.45 Alternating hyperphoria 378.50 Unspecified paralytic strabismus 378.51 Third or , partial 378.52 Third or oculomotor nerve palsy, total 378.53 Fourth or trochlear nerve palsy 378.54 Sixth or abducens nerve palsy 378.55 External ophthalmoplegia 378.56 Total ophthalmoplegia 378.60 Unspecified mechanical strabismus 378.61 Brown's (tendon) sheath syndrome Mechanical strabismus from other 378.62 musculofascial disorders Limited duction associated with other 378.63 conditions 378.71 Duane's syndrome 378.72 Progressive external ophthalmoplegia 378.73 Strabismus in other neuromuscular disorders 378.81 Palsy of conjugate gaze 378.82 Spasm of conjugate gaze 378.83 Convergence insufficiency or palsy 378.84 Convergence excess or spasm 378.85 Anomalies of divergence 378.86 Internuclear ophthalmoplegia Other dissociated deviation of eye 378.87 movements 378.9 Unspecified disorder of eye movements 379.00 Unspecified 379.01 periodica fugax 379.02 Nodular episcleritis 379.03 Anterior scleritis 379.04 Scleromalacia perforans 379.05 Scleritis with corneal involvement

26 379.06 Brawny scleritis 379.07 Posterior scleritis 379.09 Other scleritis and episcleritis 379.11 Scleral ectasia 379.12 Staphyloma posticum 379.13 Equatorial staphyloma 379.14 Anterior staphyloma, localized 379.15 Ring staphyloma 379.16 Other degenerative disorders of 379.19 Other scleral disorder 379.21 Vitreous degeneration (PVD) 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 379.29 Other disorders of vitreous 379.31 Aphakia 379.32 Subluxation of lens 379.33 Anterior dislocation of lens 379.34 Posterior dislocation of lens 379.39 Other disorders of lens 379.40 Unspecified abnormal pupillary function 379.41 379.42 (persistent), not due to miotics 379.43 (persistent), not due to mydriatics 379.45 Argyll Robertson , atypical 379.46 Tonic pupillary reaction 379.49 Other anomaly of pupillary function 379.50 Unspecified 379.51 Congenital nystagmus 379.52 Latent nystagmus 379.53 Visual deprivation nystagmus Nystagmus associated with disorders of the 379.54 vestibular system 379.55 Dissociated nystagmus 379.56 Other forms of nystagmus Nystagmus with deficiencies of saccadic eye 379.57 movements Nystagmus with deficiencies of smooth 379.58 pursuit movements 379.59 Other irregularities of eye movements Inflammation (infection) of postprocedural 379.60 bleb, unspecified Inflammation (infection) of postprocedural 379.61 bleb, stage 1 Inflammation (infection) of postprocedural 379.62 bleb, stage 2 Inflammation (infection) of postprocedural 379.63 bleb, stage 3 379.8 Other specified disorders of eye and adnexa 379.90 Unspecified disorder of eye 379.91 Pain in or around eye 379.92 Swelling or mass of eye 379.93 Redness or discharge of eye

27 379.99 Other ill-defined disorder of eye 446.5 Giant cell arteritis (Temporal Arteritis)

Use additional code to identify associated manifestations, such as: arthropathy associated with dermatological disorders (713.3),conjunctival edema (372.73), conjunctivitis (372.04, 372.33) corneal scars and opacities (371.00-371.05), corneal ulcer (370.00-370.07), edema of eyelid (374.82) inflammation of eyelid 695.13 Stevens-Johnson syndrome (373.8), keratoconjunctivitis sicca (370.33) mechanical lagophthalmos (374.22), mucositis (478.11, 528.00, 538, 616.81), stomatitis (528.00) symblepharon (372.63) Use additional E- code to identify drug, if drug-induced Use additional code to identify percentage of skin exfoliation (695.50-695.59)

710.2 Sicca syndrome (form of Dry eyes) Use additional code to identify 714.0 manifestation, as: myopathy (359.6) Rheumatoid arthritis polyneuropathy (357.1) 743.00 Clinical anophthalmos, unspecified 743.03 Cystic eyeball, congenital 743.06 Cryptophthalmos 743.10 Unspecified microphthalmos 743.11 Simple microphthalmos Microphthalmos associated with other 743.12 anomalies of eye and adnexa 743.20 Unspecified buphthalmos 743.21 Simple buphthalmos Buphthalmos associated with other ocular 743.22 anomalies 743.30 Unspecified Congenital capsular and subcapsular 743.31 cataract 743.32 Congenital cortical and zonular cataract 743.33 Congenital nuclear cataract 743.34 Congenital total and subtotal cataract 743.35 Congenital aphakia 743.36 Congenital anomalies of lens shape 743.37 Congenital ectopic lens 743.39 Other congenital cataract and lens anomalies Congenital anomaly of corneal size and 743.41 shape Corneal opacities, interfering with vision, 743.42 congenital 743.43 Other congenital corneal opacity Specified anomalies of anterior chamber, 743.44 chamber angle, and related structures 743.45 Other specified anomalies of iris and ciliary 743.46 body 743.47 Specified congenital anomaly of sclera Multiple and combined anomalies of anterior 743.48 segment

28 Other congenital anomaly of anterior 743.49 segment of 743.51 Vitreous anomaly, congenital 743.52 Fundus coloboma 743.53 Congenital chorioretinal degeneration Congenital folds and cysts of posterior 743.54 segment 743.55 Congenital macular change 743.56 Other congenital retinal changes 743.57 Specified congenital anomalies of optic disc 743.58 Vascular anomalies Other congenital anomalies of posterior 743.59 segment 743.61 Congenital ptosis of eyelid 743.62 Congenital deformity of eyelid 743.63 Other specified congenital anomaly of eyelid Specified congenital anomaly of lacrimal 743.64 gland Specified congenital anomaly of lacrimal 743.65 passages 743.66 Specified congenital anomaly of orbit Other congenital anomalies of eyelids, 743.69 lacrimal 759.82 Marfan syndrome (congenital) 790.29 Other abnormal glucose Laceration of skin of eyelid and periocular 870.0 area Laceration of eyelid, full-thickness, not 870.1 involving lacrimal passages Laceration of eyelid involving lacrimal 870.2 passages Penetrating wound of orbit, without mention 870.3 of foreign body 870.4 Penetrating wound of orbit with foreign body Other specified open wounds of ocular 870.8 adnexa 870.9 Unspecified open wound of ocular adnexa Ocular laceration without prolapse of 871.0 intraocular tissue Ocular laceration with prolapse or exposure 871.1 of intraocular tissue Rupture of eye with partial loss of intraocular 871.2 tissue 871.3 Avulsion of eye 871.4 Unspecified laceration of eye Penetration of eyeball with magnetic foreign 871.5 body Penetration of eyeball with (nonmagnetic) 871.6 foreign body 871.7 Unspecified ocular penetration 871.9 Unspecified open wound of eyeball Superficial injury of eyelids and periocular 918.0 area 918.1 Superficial injury of cornea 918.2 Superficial injury of conjunctiva

29 Other and unspecified superficial injuries of 918.9 eye 921.0 Black eye, not otherwise specified 921.1 Contusion of eyelids and periocular area 921.2 Contusion of orbital tissues 921.3 Contusion of eyeball 921.9 Unspecified contusion of eye 930.0 Foreign body in cornea 930.1 Foreign body in conjunctival sac 930.2 Foreign body in lacrimal punctum Foreign body in other and combined sites on 930.8 external eye Foreign body in unspecified site on external 930.9 eye 940.0 Chemical burn of eyelids and periocular area 940.1 Other burns of eyelids and periocular area Alkaline chemical burn of cornea and 940.2 conjunctival sac Acid chemical burn of cornea and 940.3 conjunctival sac 940.4 Other burn of cornea and conjunctival sac Burn with resulting rupture and destruction of 940.5 eyeball 940.9 Unspecified burn of eye and adnexa 950.0 Optic nerve injury 950.1 Injury to optic chiasm 950.2 Injury to optic pathways 950.3 Injury to visual cortex Injury to unspecified optic nerve and 950.9 pathways Mechanical complication of other specified 996.51 prosthetic device, implant, and graft; Due to corneal graft

Infection and inflammatory reaction due to internal prosthetic device, implant, and graft; 996.69 Due to other internal prosthetic device, implant, and graft

Other complications of internal (biological) (synthetic) prosthetic device, implant, and 996.79 graft; Due to other internal prosthetic device, implant, and graft Family history of other conditions; Blindness v19.0 or visual loss Family history of other conditions; Other Eye v19.1 Disorders V45.78 Acquired absence of organ Eye V58.67 Long-term (current) use of insulin v58.69 Long-term (current) use of other medications

Attachment II Covered & Non-Covered Procedures List

Med Policy Coverage CPT Coding Notes Description Guidelines

30 65760- Refractive Keratoplasty Not covered 65767 65771 Radial Keratotomy Not Covered 66999 Therapeutic Keratoplasty 371.42 and 371.52 only 65756- Endothelial Keratoplasty 371.23, 371.57, 996.51 65757 (Corneal Transplant)

****Not Covered under our plan deny claims-submit Appeal with clinical documentation***********See Association *****Not Covered under VT Policy * Use additional code to identify Plan***** Claims will deny associated manifestations, such as: and need to be appealed with arthropathy associated with dermatological clinical documentation. disorders (713.3), conjunctival edema **************** 369.00, (372.73), conjunctivitis (372.04, 372.33), 369.01, 369.02, 369.03, corneal scars and opacities (371.00- 369.04, 369.05, 369.06, 65770 371.05), corneal ulcer (370.00-370.07), Keratoprosthesis 369.07, 369.08, 369.60, edema of eyelid (374.82), inflammation of 369.61, 369.62, 369.63, eyelid (373.8), keratoconjunctivitis sicca 369.64, 369.65, 369.66, (370.33), mechanical lagophthalmos 369.67, 369.68, 369.69, (374.22), mucositis (478.11, 528.00, 538, 371.03, 695.13*, 940.2, 616.81), stomatitis (528.00), 940.3, 996.51, 996.69, symblepharon (372.63),Use additional E- 996.79 code to identify drug, if drug-induced Use additional code to identify percentage of skin exfoliation (695.50-695.59)

All diagnoses on Attachment 76514 Pachymetry I Ophthalmological services; medical 92002- examination and All diagnoses on Attachment

92014 evaluation with initiation of I diagnostic and treatment program

(Aphakia) 379.31 or (Keratoconus) 371.60, 371.61, 371.62 or (Eye Injuries) 871.0, 871.1, 871.2, Determination of refractive 871.3, 871.4, 871.5, 871.6, 92015 states 871.7, 871.8 871.9, 921.0, 921.1, 921.2, 921.3, 921.9, 940.0, 940.1, 940.2, 940.3, 940.4, 940.5, 940.9, 950.0, 950.1, 950.2, 950.3, 950.9.

Ophthalmological 92018- examination and All diagnoses on Attachment

92019 evaluation under general I anesthesia Gonioscopy separate All diagnoses on Attachment 92020 procedure I Computerized corneal topography, unilateral or 92025 Not covered bilateral with interpretation and report

Sensorimotor examination with multiple All diagnoses on Attachment 92060 measurements of ocular I deviation Orthoptic and/or pleoptic 92065 Not Covered training

31 with diagnosis of Aphakia 92070 Fitting of contact lens 379.31 or Keratoconus 371.60 , 371.61, 371.62 only 92081 - All diagnoses on Attachment Visual field examinations 92083 I

Scanning computerized ophthalmic diagnostic imaging (SCODI or OCT), 92132 Investigational=Not covered anterior segment, with interpretation and report, unilateral or bilateral

Scanning computerized ophthalmic diagnostic imaging (SCODI or OCT), 92133 and 92134 may NOT be reported See Attachment IV for 92133 posterior segment, with together in the same encounter covered diagnosis list. interpretation and report, unilateral or bilateral; optic nerve

Scanning computerized ophthalmic diagnostic imaging (SCODI or OCT), 92133 and 92134 may NOT be reported See Attachment IV for 92134 posterior segment, with together in the same encounter covered diagnosis list. interpretation and report, unilateral or bilateral; retina All diagnoses on Attachment 92136 Opthalmic biometry I 92100, 92120, All diagnoses on Attachment 92130, Glaucoma pressure tests I 92136, 92140

92225 – Ophthalmoscopy and All diagnoses on Attachment

92287 other specialized services I Prescription of contact Keratoconus 371.60 , 371.61, 92310 lens except aphakia 371.62 only 92311 – Prescription of contact with diagnosis of Aphakia

92312 lens for aphakia 379.31 only with diagnosis of Aphakia Prescription of 92313 379.31 or Keratoconus corneoscleral lens 371.60 , 371.61, 371.62 only Prescription of contact Keratoconus 371.60 , 371.61, 92314 lens except aphakia 371.62 only 92315 - Prescription of contact with diagnosis of Aphakia

92316 lens for aphakia 379.31 only with diagnosis of Aphakia Prescription of 92317 379.31 or Keratoconus corneoscleral lens 371.60 , 371.61, 371.62 only with diagnosis of Aphakia 92325- Contact lens 379.31 or Keratoconus 92326 371.60 , 371.61, 371.62 only 92340 – Fitting of spectacles Keratoconus 371.60-371.62

92342 except aphakia only 92352 - Fitting of spectacles for with diagnosis of Aphakia

92353 aphakia 379.31 only with diagnosis of Aphakia 92354 - Fitting of spectacles 379.31 or Keratoconus 92355 mounted low vision aid 371.60 , 371.61, 371.62 only

32 with diagnosis of Aphakia Prosthesis service for 92358 379.31 or Keratoconus aphakia, temporary 371.60 , 371.61, 371.62 only Repair and re fitting Keratoconus 371.60 , 371.61, 92370 spectacles except aphakia 371.62 only Spectacle prosthesis for with diagnosis of Aphakia 92371 aphakia 379.31 Covered if done with Visual acuity test preventive services E & M in 99173 (inclusive) accordance with national guidelines. 0181T Corneal hysteresis All diagnosis on Attachment I

Attachment III Covered & Non-Covered HCPCS List

HCPCS Coding Notes Description Med Policy Coverage Guidelines New technology Q1003 – intraocular lenses Not covered Q1005 (NTIOL)

****Not Covered under our plan deny claims-submit Appeal with clinical documentation***********See Association Policy Use additional code to identify associated manifestations, such as: arthropathy associated with dermatological disorders (713.3), ****Not Covered under our plan deny conjunctival edema (372.73), claims-submit Appeal with clinical conjunctivitis (372.04, 372.33), documentation***********Covered with corneal scars and opacities 369.00, 369.01, 369.02, 369.03, 369.04, L8609 (371.00-371.05), corneal ulcer Artificial Cornea 369.05, 369.06, 369.07, 369.08, 369.60, (370.00-370.07), edema of eyelid 369.61, 369.62, 369.63, 369.64, 369.65, (374.82), inflammation of eyelid 369.66, 369.67, 369.68, 369.69, 371.03, (373.8), keratoconjunctivitis sicca 695.13*, 940.2, 940.3, 996.51, 996.69, (370.33), mechanical 996.79 lagophthalmos (374.22), mucositis (478.11, 528.00, 538, 616.81), stomatitis (528.00), symblepharon (372.63),Use additional E-code to identify drug, if drug-induced Use additional code to identify percentage of skin exfoliation (695.50-695.59)

Covered with diagnosis recurrent erosion of Phototherapeutic S0812 the cornea (371.42) and anterior corneal Keratectomy dystrophies (371.52). V2020 – with diagnosis of Aphakia 379.31 or Frames, lenses V2499 Keratoconus 371.60 , 371.61, 371.62 only V2500 – with diagnosis of Aphakia 379.31 or Contact lenses V2599 Keratoconus 371.60 , 371.61, 371.62 only

33 Covered with 369.00, 369.01, 369.02, 369.03, 369.04, 369.05, 369.06, 369.07, Integrated 369.08, 369.60, 369.61, 369.62, 369.63, C1818 Keratoprosthesis 369.64, 369.65, 369.66, 369.67, 369.68, 369.69, 371.03, 695.13*, 940.2, 940.3, 996.51, 996.69, 996.79

With diagnosis of V45.78 and 743.0 only. V2623 Eye Prosthetic Prior approval required

Polishing/resurfacing V2624 NO PA required of ocular prosthetic

V2625 - With diagnosis of V45.78 and 743.0 only. Eye Prosthesis V2629 Prior approval required with diagnosis of Aphakia 379.31 or V2745 Addition to lens Keratoconus 371.60 , 371.61, 371.62 only Presbyopia V2788 correcting function of Not covered intraocular lens

Attachment IV Covered Diagnoses for 92133 & 92134 OCT/SCODI List

ICD- Coding Notes Description Med Policy Notes 9 Allow codes 92133, 92134; scanning Histoplasma capsulatum computerized ophthalmic diagnostic imaging, 115.02 retinitis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Unspecified Histoplasmosis computerized ophthalmic diagnostic imaging, 115.92 retinitis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of computerized ophthalmic diagnostic imaging, 190.6 choroid posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of other computerized ophthalmic diagnostic imaging, 190.8 specified sites of eye posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of eye, computerized ophthalmic diagnostic imaging, 190.9 part unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of brain; computerized ophthalmic diagnostic imaging, 191.0 Cerebrum, except lobes and posterior segment w/interpretation & report ventricles unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of brain; computerized ophthalmic diagnostic imaging, 191.1 Frontal lobe posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of brain; computerized ophthalmic diagnostic imaging, 191.2 Temporal lobe posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

34 Allow codes 92133, 92134; scanning Malignant neoplasm of brain; computerized ophthalmic diagnostic imaging, 191.3 Parietal lobe posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of brain; computerized ophthalmic diagnostic imaging, 191.4 Occipital lobe posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of brain; computerized ophthalmic diagnostic imaging, 191.5 Ventricles posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of brain; computerized ophthalmic diagnostic imaging, 191.6 Cerebellum NOS posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of brain; computerized ophthalmic diagnostic imaging, 191.7 Brain stem posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of brain: computerized ophthalmic diagnostic imaging, 191.8 Other parts of brain posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of brain, computerized ophthalmic diagnostic imaging, 191.9 unspecified site posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of cranial computerized ophthalmic diagnostic imaging, 192.0 nerves posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of computerized ophthalmic diagnostic imaging, 192.1 cerebral meninges posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of spinal computerized ophthalmic diagnostic imaging, 192.2 cord posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of spinal computerized ophthalmic diagnostic imaging, 192.3 meninges posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of other computerized ophthalmic diagnostic imaging, 192.8 specified sites of nervous posterior segment w/interpretation & report systems unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of computerized ophthalmic diagnostic imaging, 192.9 nervous system, part posterior segment w/interpretation & report unspecified unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of thyroid computerized ophthalmic diagnostic imaging, 193 gland posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

35 Allow codes 92133, 92134; scanning Malignant neoplasm of computerized ophthalmic diagnostic imaging, 194.0 adrenal gland posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of computerized ophthalmic diagnostic imaging, 194.1 parathyroid gland posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of computerized ophthalmic diagnostic imaging, 194.3 pituitary gland and posterior segment w/interpretation & report craniopharyngeal duct unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of pineal computerized ophthalmic diagnostic imaging, 194.4 gland posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of carotid computerized ophthalmic diagnostic imaging, 194.5 body posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of Aortic computerized ophthalmic diagnostic imaging, 194.6 body and other paraganglia posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of other computerized ophthalmic diagnostic imaging, 194.8 endocrine glands posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of computerized ophthalmic diagnostic imaging, 194.9 endocrine gland, site posterior segment w/interpretation & report unspecified unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of head, computerized ophthalmic diagnostic imaging, 195.0 face, and neck posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 195.1 Malignant neoplasm of thorax posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of computerized ophthalmic diagnostic imaging, 195.2 abdomen posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 195.3 Malignant neoplasm of pelvis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of upper computerized ophthalmic diagnostic imaging, 195.4 limb posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Malignant neoplasm of lower computerized ophthalmic diagnostic imaging, 195.5 limb posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

36 Allow codes 92133, 92134; scanning Malignant neoplasm of other computerized ophthalmic diagnostic imaging, 195.8 specified sites posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Secondary and unspecified Allow codes 92133, 92134; scanning malignant neoplasm of computerized ophthalmic diagnostic imaging, 196.0 Lymph nodes of head, face, posterior segment w/interpretation & report and neck unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary and unspecified computerized ophthalmic diagnostic imaging, 196.1 malignant neoplasm of posterior segment w/interpretation & report Intrathoracic lymph nodes unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary and unspecified computerized ophthalmic diagnostic imaging, 196.2 malignant neoplasm of Intra- posterior segment w/interpretation & report abdominal lymph nodes unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary and unspecified computerized ophthalmic diagnostic imaging, 196.3 malignant neoplasm of Lymph posterior segment w/interpretation & report nodes of axilla and upper limb unilateral & bilateral; Optic Nerve or Retina

Secondary and unspecified Allow codes 92133, 92134; scanning malignant neoplasm of Lymph computerized ophthalmic diagnostic imaging, 196.5 nodes of inguinal region and posterior segment w/interpretation & report lower limb unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary and unspecified computerized ophthalmic diagnostic imaging, 196.6 malignant neoplasm of posterior segment w/interpretation & report Intrapelvic lymph nodes unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary and unspecified computerized ophthalmic diagnostic imaging, 196.8 malignant neoplasm of Lymph posterior segment w/interpretation & report nodes of multiple sites unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary and unspecified computerized ophthalmic diagnostic imaging, 196.9 malignant neoplasm of lymph posterior segment w/interpretation & report node site unspecified unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 197.0 neoplasm of lung posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 197.1 neoplasm of mediastinum posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 197.2 neoplasm of pleura posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 197.3 neoplasm of Other respiratory posterior segment w/interpretation & report organs unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 197.4 neoplasm of Small intestine, posterior segment w/interpretation & report including duodenum unilateral & bilateral; Optic Nerve or Retina

37 Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 197.5 neoplasm of large intestine posterior segment w/interpretation & report and rectum unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 197.6 neoplasm of retroperitoneum posterior segment w/interpretation & report and peritoneum unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 197.7 neoplasm of Liver, specified posterior segment w/interpretation & report as secondary unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 197.8 neoplasm of Other digestive posterior segment w/interpretation & report organs and spleen unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 198.0 neoplasm of kidney posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 198.1 neoplasm of Other urinary posterior segment w/interpretation & report organs unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 198.2 neoplasm of skin posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary malignant computerized ophthalmic diagnostic imaging, 198.3 neoplasm of Brain and spinal posterior segment w/interpretation & report cord unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 224.6 Benign neoplasm of choroid posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of other computerized ophthalmic diagnostic imaging, 224.8 specified parts of eye posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 225.0 Benign neoplasm of brain posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of cranial computerized ophthalmic diagnostic imaging, 225.1 nerves posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of cerebral computerized ophthalmic diagnostic imaging, 225.2 meninges posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of spinal computerized ophthalmic diagnostic imaging, 225.3 cord posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

38 Allow codes 92133, 92134; scanning Benign neoplasm of spinal computerized ophthalmic diagnostic imaging, 225.4 meninges posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of other computerized ophthalmic diagnostic imaging, 225.8 specified sites of nervous posterior segment w/interpretation & report system unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of Nervous computerized ophthalmic diagnostic imaging, 225.9 system, part unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of thyroid computerized ophthalmic diagnostic imaging, 226 glands posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of adrenal computerized ophthalmic diagnostic imaging, 227.0 gland posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of computerized ophthalmic diagnostic imaging, 227.1 parathyroid gland posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of pituitary computerized ophthalmic diagnostic imaging, 227.3 gland and craniopharyngeal posterior segment w/interpretation & report duct (pouch) unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of pineal computerized ophthalmic diagnostic imaging, 227.4 gland posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of carotid computerized ophthalmic diagnostic imaging, 227.5 body posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of Aortic computerized ophthalmic diagnostic imaging, 227.6 body and other paraganglia posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of other computerized ophthalmic diagnostic imaging, 227.8 endocrine glands posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of computerized ophthalmic diagnostic imaging, 227.9 endocrine gland, site posterior segment w/interpretation & report unspecified unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Hemangioma of unspecified computerized ophthalmic diagnostic imaging, 228.00 site posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Hemangioma of skin and computerized ophthalmic diagnostic imaging, 228.01 subcutaneous tissue posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

39 Allow codes 92133, 92134; scanning Hemangioma of intracranial computerized ophthalmic diagnostic imaging, 228.02 structures posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 228.03 Hemangioma of retina posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Hemangioma of intra- computerized ophthalmic diagnostic imaging, 228.04 abdominal structures posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 228.09 Hemangioma of other sites posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 228.1 Lymphangioma, any site posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of lymph computerized ophthalmic diagnostic imaging, 229.0 nodes posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of other computerized ophthalmic diagnostic imaging, 229.8 specified sites posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Benign neoplasm of computerized ophthalmic diagnostic imaging, 229.9 unspecified site posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of Lip, oral computerized ophthalmic diagnostic imaging, 230.0 cavity, and pharynx posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of computerized ophthalmic diagnostic imaging, 230.1 esophagus posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 230.2 Carcinoma in situ of stomach posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 230.3 Carcinoma in situ of colon posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 230.4 Carcinoma in situ of rectum posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of anal computerized ophthalmic diagnostic imaging, 230.5 canal posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

40 Allow codes 92133, 92134; scanning Carcinoma in situ of anus, computerized ophthalmic diagnostic imaging, 230.6 unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of other and computerized ophthalmic diagnostic imaging, 230.7 unspecified parts of intestines posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of liver and computerized ophthalmic diagnostic imaging, 230.8 biliary system posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of other and computerized ophthalmic diagnostic imaging, 230.9 unspecified digestive organs posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 231.0 Carcinoma in situ of larynx posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 231.1 Carcinoma in situ of trachea posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of bronchus computerized ophthalmic diagnostic imaging, 231.2 and lung posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of Other computerized ophthalmic diagnostic imaging, 231.8 specified parts of respiratory posterior segment w/interpretation & report system unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of computerized ophthalmic diagnostic imaging, 231.9 Respiratory system, part posterior segment w/interpretation & report unspecified unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 232.0 Carcinoma in situ of skin of lip posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of eyelid, computerized ophthalmic diagnostic imaging, 232.1 including canthus posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of skin of computerized ophthalmic diagnostic imaging, 232.2 Ear and external auditory posterior segment w/interpretation & report canal unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of skin of computerized ophthalmic diagnostic imaging, 232.3 other and unspecified parts of posterior segment w/interpretation & report face unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of scalp computerized ophthalmic diagnostic imaging, 232.4 and skin of neck posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

41 Allow codes 92133, 92134; scanning Carcinoma in situ of skin of computerized ophthalmic diagnostic imaging, 232.5 trunk, except scroctum posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of skin of computerized ophthalmic diagnostic imaging, 232.6 upper limb, including shoulder posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of skin of computerized ophthalmic diagnostic imaging, 232.7 lower limb, including hip posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of Other computerized ophthalmic diagnostic imaging, 232.8 specified sites of skin posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of skin, site computerized ophthalmic diagnostic imaging, 232.9 unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 233.0 Carcinoma in situ of breast posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of Cervix computerized ophthalmic diagnostic imaging, 233.1 uteri posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of other and computerized ophthalmic diagnostic imaging, 233.2 unspecified parts of uterus posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of computerized ophthalmic diagnostic imaging, 233.30 Unspecified female genital posterior segment w/interpretation & report organ unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 233.31 Carcinoma in situ of Vagina posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 233.32 Carcinoma in situ of Vulva posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of Other computerized ophthalmic diagnostic imaging, 233.39 female genital organ posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 233.4 Carcinoma in situ of prostate posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 233.5 Carcinoma in situ of penis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

42 Allow codes 92133, 92134; scanning Carcinoma in situ of other and computerized ophthalmic diagnostic imaging, 233.6 unspecified male genital posterior segment w/interpretation & report organs unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 233.7 Carcinoma in situ of bladder posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of other and computerized ophthalmic diagnostic imaging, 233.9 unspecified urinary organs posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 234.0 Carcinoma in situ of eye posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Carcinoma in situ of other computerized ophthalmic diagnostic imaging, 234.8 specified sites posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 235.1 behavior of Lip, oral cavity, posterior segment w/interpretation & report and pharynx unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 235.2 behavior of Stomach, posterior segment w/interpretation & report intestines, and rectum unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 235.3 behavior of Liver and biliary posterior segment w/interpretation & report passages unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 235.4 behavior of Retroperitoneum posterior segment w/interpretation & report and peritoneum unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 235.5 behavior of Other and posterior segment w/interpretation & report unspecified digestive organs unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 235.6 behavior of larynx posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 235.7 behavior of Trachea, posterior segment w/interpretation & report bronchus, and lung unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 235.8 behavior of Pleura, thymus, posterior segment w/interpretation & report and mediastinum unilateral & bilateral; Optic Nerve or Retina

Neoplasm of uncertain Allow codes 92133, 92134; scanning behavior of Other and computerized ophthalmic diagnostic imaging, 235.9 unspecified respiratory posterior segment w/interpretation & report organs unilateral & bilateral; Optic Nerve or Retina

43 Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 236.0 behavior of uterus posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 236.1 behavior of placenta posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 236.2 behavior of ovary posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Neoplasm of uncertain Allow codes 92133, 92134; scanning behavior of Other and computerized ophthalmic diagnostic imaging, 236.3 unspecified female genital posterior segment w/interpretation & report organs unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 236.4 behavior of testis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 236.5 behavior of prostate posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Neoplasm of uncertain Allow codes 92133, 92134; scanning behavior of Other and computerized ophthalmic diagnostic imaging, 236.6 unspecified male genital posterior segment w/interpretation & report organs unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 236.7 behavior of bladder posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 236.90 behavior of Urinary organ, posterior segment w/interpretation & report unspecified unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 236.91 behavior of Kidney and ureter posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 236.99 behavior of Other posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 237.0 behavior of Pituitary gland posterior segment w/interpretation & report and craniopharyngeal duct unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 237.1 behavior of pineal gland posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 237.2 behavior of adrenal gland posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

44 Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 237.3 behavior of paraganglia posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 237.4 behavior of Other and posterior segment w/interpretation & report unspecified endocrine glands unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 237.5 behavior of Brain and spinal posterior segment w/interpretation & report cord unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 237.6 behavior of meninges posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neurofibromatosis, computerized ophthalmic diagnostic imaging, 237.70 unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neurofibromatosis, type 1 computerized ophthalmic diagnostic imaging, 237.71 [von Recklinghausen's posterior segment w/interpretation & report disease] unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neurofibromatosis, type 2 computerized ophthalmic diagnostic imaging, 237.72 [acoustic neurofibromatosis] posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 237.73 Schwannomatosis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 237.79 Other neurofibromatosis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Neoplasm of uncertain Allow codes 92133, 92134; scanning behavior of Other and computerized ophthalmic diagnostic imaging, 237.9 unspecified parts of nervous posterior segment w/interpretation & report system unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 238.0 behavior of Bone and articular posterior segment w/interpretation & report cartilage unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 238.1 behavior of Connective and posterior segment w/interpretation & report other soft tissue unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 238.2 behavior of skin posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 238.3 behavior of breast posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

45 Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 238.4 behavior of polycythemia vera posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 238.5 behavior of Histiocytic and posterior segment w/interpretation & report mast cells unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 238.6 behavior of plasma cells posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 238.71 Essential thrombocythemia posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Low grade myelodysplastic computerized ophthalmic diagnostic imaging, 238.72 syndrome lesions posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning High grade myelodysplastic computerized ophthalmic diagnostic imaging, 238.73 syndrome lesions posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Myelodysplastic syndrome computerized ophthalmic diagnostic imaging, 238.74 with 5q deletion posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Myelodysplastic syndrome, computerized ophthalmic diagnostic imaging, 238.75 unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Myelofibrosis with myeloid computerized ophthalmic diagnostic imaging, 238.76 metaplasia posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Code first Allow codes 92133, 92134; scanning Post-transplant complications of computerized ophthalmic diagnostic imaging, 238.77 lymphoproliferative disorder transplant (996.80- posterior segment w/interpretation & report [PTLD] 996.89) unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Other lymphatic and computerized ophthalmic diagnostic imaging, 238.79 hematopoietic tissues posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 238.8 behavior of Other specified posterior segment w/interpretation & report sites unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of uncertain computerized ophthalmic diagnostic imaging, 238.9 behavior, Site unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of unspecified computerized ophthalmic diagnostic imaging, 239.0 nature of Digestive system posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

46 Allow codes 92133, 92134; scanning Neoplasm of unspecified computerized ophthalmic diagnostic imaging, 239.1 nature of Respiratory system posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasms of unspecified computerized ophthalmic diagnostic imaging, 239.2 nature of Bone, soft tissue, posterior segment w/interpretation & report and skin unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of unspecified computerized ophthalmic diagnostic imaging, 239.3 nature of breast posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of unspecified computerized ophthalmic diagnostic imaging, 239.4 nature of bladder posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of unspecified computerized ophthalmic diagnostic imaging, 239.5 nature of Other genitourinary posterior segment w/interpretation & report organs unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Neoplasm of unspecified computerized ophthalmic diagnostic imaging, 239.6 nature of brain posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Neoplasm of unspecified Allow codes 92133, 92134; scanning nature of Endocrine glands computerized ophthalmic diagnostic imaging, 239.7 and other parts of nervous posterior segment w/interpretation & report system unilateral & bilateral; Optic Nerve or Retina

Use additional code to identify manifestation, as: diabetic: blindness (369.00-369.9), Diabetes with ophthalmic Allow codes 92133, 92134; scanning cataract (366.41), manifestations, type II or computerized ophthalmic diagnostic imaging, 250.50 glaucoma (365.44), unspecified type, not stated posterior segment w/interpretation & report macular edema as uncontrolled unilateral & bilateral; Optic Nerve or Retina (362.07), retinal edema (362.07), retinopathy (362.01- 362.07)

Use additional code to identify manifestation, as: diabetic: blindness (369.00-369.9), Diabetes with ophthalmic Allow codes 92133, 92134; scanning cataract (366.41), manifestations, type I computerized ophthalmic diagnostic imaging, 250.51 glaucoma (365.44), [juvenile type], not stated as posterior segment w/interpretation & report macular edema uncontrolled unilateral & bilateral; Optic Nerve or Retina (362.07), retinal edema (362.07), retinopathy (362.01- 362.07)

47 Use additional code to identify manifestation, as: diabetic: blindness (369.00-369.9), Allow codes 92133, 92134; scanning cataract (366.41), Diabetes with ophthalmic computerized ophthalmic diagnostic imaging, 250.52 glaucoma (365.44), manifestations, type II or posterior segment w/interpretation & report macular edema unspecified type, uncontrolled unilateral & bilateral; Optic Nerve or Retina (362.07), retinal edema (362.07), retinopathy (362.01- 362.07)

Use additional code to identify manifestation, as: diabetic: blindness (369.00-369.9), Allow codes 92133, 92134; scanning cataract (366.41), Diabetes with ophthalmic computerized ophthalmic diagnostic imaging, 250.53 glaucoma (365.44), manifestations, type I posterior segment w/interpretation & report macular edema [juvenile type], uncontrolled unilateral & bilateral; Optic Nerve or Retina (362.07), retinal edema (362.07), retinopathy (362.01- 362.07)

Allow codes 92133, 92134; scanning Benign intracranial computerized ophthalmic diagnostic imaging, 348.2 hypertension (Pseudotumor posterior segment w/interpretation & report Cerebri) unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 360.11 Sympathetic uveitis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Progressive high computerized ophthalmic diagnostic imaging, 360.21 (degenerative) myopia posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 360.30 Unspecified hypotony of eye posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 360.31 Primary hypotony of eye posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Ocular fistula causing computerized ophthalmic diagnostic imaging, 360.32 hypotony posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Hypotony associated with computerized ophthalmic diagnostic imaging, 360.33 other ocular disorders posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 360.34 Flat anterior chamber of eye posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Retinal detachment with computerized ophthalmic diagnostic imaging, 361.00 retinal defect, unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

48 Allow codes 92133, 92134; scanning Recent detachment, partial, computerized ophthalmic diagnostic imaging, 361.01 with single defect posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Recent detachment, partial, computerized ophthalmic diagnostic imaging, 361.02 with multiple defects posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Recent detachment, partial, computerized ophthalmic diagnostic imaging, 361.03 with giant tear posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Recent detachment, partial, computerized ophthalmic diagnostic imaging, 361.04 with retinal dialysis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Recent detachment, total or computerized ophthalmic diagnostic imaging, 361.05 subtotal posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 361.06 Old detachment, partial posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Old detachment, total or computerized ophthalmic diagnostic imaging, 361.07 subtotal posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 361.10 Unspecified retinoschisis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 361.2 Serous retinal detachment posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 361.81 Traction detachment of retina posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Code first diabetes Background diabetic computerized ophthalmic diagnostic imaging, 362.01 (249.5, 250.5) retinopathy (BDR) posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Code first diabetes Proliferative diabetic computerized ophthalmic diagnostic imaging, 362.02 (249.5, 250.5) retinopathy (PDR) posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Code first diabetes Nonproliferative diabetic computerized ophthalmic diagnostic imaging, 362.03 (249.5, 250.5) retinopathy NOS (NPDR) posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Code first diabetes Mild nonproliferative diabetic computerized ophthalmic diagnostic imaging, 362.04 (249.5, 250.5) retinopathy posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

49 Allow codes 92133, 92134; scanning Code first diabetes Moderate nonproliferative computerized ophthalmic diagnostic imaging, 362.05 (249.5, 250.5) diabetic retinopathy posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Code first diabetes Severe nonproliferative computerized ophthalmic diagnostic imaging, 362.06 (249.5, 250.5) diabetic retinopathy posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Code 362.07 must be used with a code for diabetic retinopathy Allow codes 92133, 92134; scanning (362.01-362.06) computerized ophthalmic diagnostic imaging, 362.07 Diabetic macular edema *****Also Code first posterior segment w/interpretation & report diabetes (249.5, unilateral & bilateral; Optic Nerve or Retina 250.5) prior to 362.01- 362.06 codes*****

Allow codes 92133, 92134; scanning Background retinopathy, computerized ophthalmic diagnostic imaging, 362.10 unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Hypertensive Retinopathy Two codes are necessary to identify the condition. First assign Allow codes 92133, 92134; scanning the code from computerized ophthalmic diagnostic imaging, 362.11 subcategory 362.11, Hypertensive retinopathy posterior segment w/interpretation & report Hypertensive unilateral & bilateral; Optic Nerve or Retina retinopathy, then the appropriate code from categories 401-405 to indicate the type of hypertension.

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 362.12 Exudative retinopathy posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Use additional code Allow codes 92133, 92134; scanning for any associated Changes in vascular computerized ophthalmic diagnostic imaging, 362.13 atherosclerosis appearance of retina posterior segment w/interpretation & report (440.8) unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 362.14 Retinal microaneurysms NOS posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 362.15 Retinal telangiectasia posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Retinal neovascularization computerized ophthalmic diagnostic imaging, 362.16 NOS posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Other intraretinal computerized ophthalmic diagnostic imaging, 362.17 microvascular abnormalities posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

50 Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 362.18 Retinal vasculitis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Central retinal artery computerized ophthalmic diagnostic imaging, 362.31 occlusion (CRAO) posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 362.32 Arterial branch occlusion posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Central retinal vein occlusion computerized ophthalmic diagnostic imaging, 362.35 (CRVO) posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Venous tributary (branch) computerized ophthalmic diagnostic imaging, 362.36 occlusion (BRVO) posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Venous engorgement of computerized ophthalmic diagnostic imaging, 362.37 retina posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Retinal layer separation, computerized ophthalmic diagnostic imaging, 362.40 unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 362.41 Central serous retinopathy posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Serous detachment of retinal computerized ophthalmic diagnostic imaging, 362.42 pigment epithelium (RPE) posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Hemorrhagic detachment of computerized ophthalmic diagnostic imaging, 362.43 retinal pigment epithelium posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Macular degeneration computerized ophthalmic diagnostic imaging, 362.50 (senile), unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Nonexudative senile macular computerized ophthalmic diagnostic imaging, 362.51 degeneration posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Exudative senile macular computerized ophthalmic diagnostic imaging, 362.52 degeneration posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 362.53 Cystoid macular degeneration posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

51 Allow codes 92133, 92134; scanning Macular cyst, hole, or computerized ophthalmic diagnostic imaging, 362.54 pseudohole of retina posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 362.55 Toxic maculopathy of retina posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Macular puckering of retina computerized ophthalmic diagnostic imaging, 362.56 (ERM) posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Drusen (degenerative) of computerized ophthalmic diagnostic imaging, 362.57 retina posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Unspecified peripheral retinal computerized ophthalmic diagnostic imaging, 362.60 degeneration posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Paving stone degeneration of computerized ophthalmic diagnostic imaging, 362.61 peripheral retina posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Microcystoid degeneration of computerized ophthalmic diagnostic imaging, 362.62 peripheral retina posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Lattice degeneration of computerized ophthalmic diagnostic imaging, 362.63 peripheral retina posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Senile reticular degeneration computerized ophthalmic diagnostic imaging, 362.64 of peripheral retina posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary pigmentary computerized ophthalmic diagnostic imaging, 362.65 degeneration of peripheral posterior segment w/interpretation & report retina unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Secondary vitreoretinal computerized ophthalmic diagnostic imaging, 362.66 degenerations posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Unspecified hereditary retinal computerized ophthalmic diagnostic imaging, 362.70 dystrophy posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina Code first underlying disease, as: Allow codes 92133, 92134; scanning cerebroretinal Retinal dystrophy in systemic computerized ophthalmic diagnostic imaging, 362.71 lipidoses (330.1) or cerebroretinal lipidoses posterior segment w/interpretation & report systemic lipidoses unilateral & bilateral; Optic Nerve or Retina (272.7)

52 Code first underlying Allow codes 92133, 92134; scanning disease, as: Bassen- Retinal dystrophy in other computerized ophthalmic diagnostic imaging, 362.72 Kornzweig syndrome systemic disorders and posterior segment w/interpretation & report (272.5), Refsum's syndromes unilateral & bilateral; Optic Nerve or Retina disease (356.3)

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 362.73 Vitreoretinal dystrophies posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 362.74 Pigmentary retinal dystrophy posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Other dystrophies primarily computerized ophthalmic diagnostic imaging, 362.75 involving the sensory retina posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Dystrophies primarily computerized ophthalmic diagnostic imaging, 362.76 involving the retinal pigment posterior segment w/interpretation & report epithelium unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Dystrophies primarily computerized ophthalmic diagnostic imaging, 362.77 involving Bruch's membrane posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 362.81 Retinal hemorrhage posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Retinal exudates and computerized ophthalmic diagnostic imaging, 362.82 deposits posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 362.83 Retinal edema posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Retinal nerve fiber bundle computerized ophthalmic diagnostic imaging, 362.85 defects posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Focal chorioretinitis, computerized ophthalmic diagnostic imaging, 363.00 unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Focal choroiditis and computerized ophthalmic diagnostic imaging, 363.01 chorioretinitis, juxtapapillary posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Focal choroiditis and computerized ophthalmic diagnostic imaging, 363.03 chorioretinitis of other posterior segment w/interpretation & report posterior pole unilateral & bilateral; Optic Nerve or Retina

53 Allow codes 92133, 92134; scanning Focal choroiditis and computerized ophthalmic diagnostic imaging, 363.04 chorioretinitis, peripheral posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Focal retinitis and computerized ophthalmic diagnostic imaging, 363.05 retinochoroiditis, posterior segment w/interpretation & report juxtapapillary unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Focal retinitis and computerized ophthalmic diagnostic imaging, 363.06 retinochoroiditis, macular or posterior segment w/interpretation & report paramacular unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Focal retinitis and computerized ophthalmic diagnostic imaging, 363.07 retinochoroiditis of other posterior segment w/interpretation & report posterior pole unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Focal retinitis and computerized ophthalmic diagnostic imaging, 363.08 retinochoroiditis, peripheral posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Disseminated chorioretinitis, computerized ophthalmic diagnostic imaging, 363.10 unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Disseminated choroiditis and computerized ophthalmic diagnostic imaging, 363.11 chorioretinitis, posterior pole posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Disseminated choroiditis and computerized ophthalmic diagnostic imaging, 363.12 chorioretinitis, peripheral posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Code first any Allow codes 92133, 92134; scanning underlying disease, Disseminated choroiditis and computerized ophthalmic diagnostic imaging, 363.13 as: tuberculosis chorioretinitis, generalized posterior segment w/interpretation & report (017.3) unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Disseminated retinitis and computerized ophthalmic diagnostic imaging, 363.14 retinochoroiditis, metastatic posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Disseminated retinitis and computerized ophthalmic diagnostic imaging, 363.15 retinochoroiditis, pigment posterior segment w/interpretation & report epitheliopathy unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.20 Unspecified chorioretinitis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.21 Pars planitis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.22 Harada's disease posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

54 Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.30 Unspecified chorioretinal scar posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.31 Solar retinopathy posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.32 Other macular scars posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.33 Other scars of posterior pole posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.34 Peripheral scars posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.35 Disseminated scars posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Unspecified choroidal computerized ophthalmic diagnostic imaging, 363.40 degeneration posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.41 Senile atrophy of choroid posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Diffuse secondary atrophy of computerized ophthalmic diagnostic imaging, 363.42 choroid posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.43 Angioid streaks of choroid posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Unspecified choroidal computerized ophthalmic diagnostic imaging, 363.61 hemorrhage posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.63 Choroidal rupture posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Unspecified choroidal computerized ophthalmic diagnostic imaging, 363.70 detachment posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 363.71 Serous choroidal detachment posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

55 Allow codes 92133, 92134; scanning Hemorrhagic choroidal computerized ophthalmic diagnostic imaging, 363.72 detachment posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 364.22 Glaucomatocyclitic crises posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Recession of chamber angle computerized ophthalmic diagnostic imaging, 364.77 of eye posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 365.00 Preglaucoma, unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Open angle with borderline computerized ophthalmic diagnostic imaging, 365.01 findings posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 365.02 Anatomical narrow angle posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 365.03 Steroid responders posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 365.04 Ocular hypertension posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Unspecified open-angle computerized ophthalmic diagnostic imaging, 365.10 glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Primary open-angle glaucoma computerized ophthalmic diagnostic imaging, 365.11 (POAG or COAG) posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Low tension open-angle computerized ophthalmic diagnostic imaging, 365.12 glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Pigmentary open-angle computerized ophthalmic diagnostic imaging, 365.13 glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Open-angle glaucoma of computerized ophthalmic diagnostic imaging, 365.14 childhood posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Residual stage of open angle computerized ophthalmic diagnostic imaging, 365.15 glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

56 Allow codes 92133, 92134; scanning Primary angle-closure computerized ophthalmic diagnostic imaging, 365.20 glaucoma, unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Intermittent angle-closure computerized ophthalmic diagnostic imaging, 365.21 glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Acute angle-closure computerized ophthalmic diagnostic imaging, 365.22 glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Chronic angle-closure computerized ophthalmic diagnostic imaging, 365.23 glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Residual stage of angle- computerized ophthalmic diagnostic imaging, 365.24 closure glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 365.31 Glaucomatous stage posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 365.32 Residual stage posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Glaucoma associated with computerized ophthalmic diagnostic imaging, 365.41 chamber angle anomalies posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Glaucoma associated with computerized ophthalmic diagnostic imaging, 365.42 anomalies of iris posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Glaucoma associated with computerized ophthalmic diagnostic imaging, 365.43 other anterior segment posterior segment w/interpretation & report anomalies unilateral & bilateral; Optic Nerve or Retina Code first associated disease, as Allow codes 92133, 92134; scanning neurofibromatosis Glaucoma associated with computerized ophthalmic diagnostic imaging, 365.44 (237.70-237.79) systemic syndromes posterior segment w/interpretation & report Sturge-Weber (- unilateral & bilateral; Optic Nerve or Retina Dimitri) syndrome (759.6), Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 365.51 Phacolytic glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 365.52 Pseudoexfoliation glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

57 Allow codes 92133, 92134; scanning Glaucoma associated with computerized ophthalmic diagnostic imaging, 365.59 other lens disorders posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Glaucoma associated with computerized ophthalmic diagnostic imaging, 365.60 unspecified ocular disorder posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Glaucoma associated with computerized ophthalmic diagnostic imaging, 365.61 pupillary block posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Glaucoma associated with computerized ophthalmic diagnostic imaging, 365.62 ocular inflammations posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Glaucoma associated with computerized ophthalmic diagnostic imaging, 365.63 vascular disorders posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Glaucoma associated with computerized ophthalmic diagnostic imaging, 365.64 tumors or cysts posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Glaucoma associated with computerized ophthalmic diagnostic imaging, 365.65 ocular trauma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 365.81 Hypersecretion glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Glaucoma with increased computerized ophthalmic diagnostic imaging, 365.82 episcleral venous pressure posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 365.83 Aqueous misdirection posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 365.89 Other specified glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 365.9 Unspecified glaucoma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Visual field defect, computerized ophthalmic diagnostic imaging, 368.40 unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Scotoma involving central computerized ophthalmic diagnostic imaging, 368.41 area posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

58 Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 368.42 Scotoma of blind spot area posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 368.43 Sector or arcuate defects posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Other localized visual field computerized ophthalmic diagnostic imaging, 368.44 defect posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Generalized contraction or computerized ophthalmic diagnostic imaging, 368.45 constriction posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Unspecified acute computerized ophthalmic diagnostic imaging, 376.00 inflammation of orbit posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.01 Orbital cellulitis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.02 Orbital periostitis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.03 Orbital osteomyelitis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.04 Orbital tenonitis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Unspecified chronic computerized ophthalmic diagnostic imaging, 376.10 inflammation of orbit posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.11 Orbital granuloma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.12 Orbital myositis posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Code first underlying disease, as: hydatid Allow codes 92133, 92134; scanning infestation of orbit computerized ophthalmic diagnostic imaging, 376.13 Parasitic infestation of orbit (122.3, 122.6, 122.9) posterior segment w/interpretation & report myiasis of orbit unilateral & bilateral; Optic Nerve or Retina (134.0)

59 Allow codes 92133, 92134; scanning Code first underlying computerized ophthalmic diagnostic imaging, 376.21 thyroid disorder Thyrotoxic exophthalmos posterior segment w/interpretation & report (242.0-242.9) unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Code first underlying Exophthalmic computerized ophthalmic diagnostic imaging, 376.22 thyroid disorder ophthalmoplegia posterior segment w/interpretation & report (242.0-242.9) unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.30 Unspecified exophthalmos posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.31 Constant exophthalmos posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.32 Orbital hemorrhage posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.33 Orbital edema or congestion posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.34 Intermittent exophthalmos posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.35 Pulsating exophthalmos posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Lateral displacement of globe computerized ophthalmic diagnostic imaging, 376.36 of eye posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.40 Unspecified deformity of orbit posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.41 Hypertelorism of orbit posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.42 Exostosis of orbit posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Local deformities due to bone computerized ophthalmic diagnostic imaging, 376.43 disease posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Orbital deformities associated computerized ophthalmic diagnostic imaging, 376.44 with craniofacial deformities posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

60 Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.45 Atrophy of orbit posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.46 Enlargement of orbit posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Deformity of orbit due to computerized ophthalmic diagnostic imaging, 376.47 trauma or surgery posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Enophthalmos, unspecified as computerized ophthalmic diagnostic imaging, 376.50 to cause posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Enophthalmos due to atrophy computerized ophthalmic diagnostic imaging, 376.51 of orbital tissue posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Enophthalmos due to trauma computerized ophthalmic diagnostic imaging, 376.52 or surgery posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Use additional code to Retained (old) foreign body computerized ophthalmic diagnostic imaging, 376.6 identify foreign body following penetrating wound posterior segment w/interpretation & report (V90.01-V90.9) of orbit unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.81 Orbital cysts posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Myopathy of extraocular computerized ophthalmic diagnostic imaging, 376.82 muscles posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.89 Other orbital disorder posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 376.9 Unspecified disorder of orbit posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.00 Unspecified papilledema posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Papilledema associated with computerized ophthalmic diagnostic imaging, 377.01 increased intracranial posterior segment w/interpretation & report pressure unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Papilledema associated with computerized ophthalmic diagnostic imaging, 377.02 decreased ocular pressure posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

61 Allow codes 92133, 92134; scanning Papilledema associated with computerized ophthalmic diagnostic imaging, 377.03 retinal disorder posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.04 Foster-Kennedy syndrome posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.10 Optic atrophy, unspecified posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.10 Unspecified optic atrophy posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Glaucomatous atrophy computerized ophthalmic diagnostic imaging, 377.14 (cupping) of optic disc posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.15 Partial optic atrophy posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.16 Hereditary optic atrophy posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.21 Drusen of optic disc posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.22 Crater-like holes of optic disc posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.23 Coloboma of optic disc posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.24 Pseudopapilledema posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.41 Ischemic optic neuropathy posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Hemorrhage in optic nerve computerized ophthalmic diagnostic imaging, 377.42 sheaths posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.43 Optic nerve hypoplasia posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

62 Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.49 Other disorder of optic nerve posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Associated with pituitary computerized ophthalmic diagnostic imaging, 377.51 neoplasms and disorders posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Associated with other computerized ophthalmic diagnostic imaging, 377.52 neoplasms posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Associated with vascular computerized ophthalmic diagnostic imaging, 377.53 disorders posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Associated with inflammatory computerized ophthalmic diagnostic imaging, 377.54 disorders posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 377.61 Associated with neoplasms posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Associated with vascular computerized ophthalmic diagnostic imaging, 377.62 disorders posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Associated with inflammatory computerized ophthalmic diagnostic imaging, 377.63 disorders posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Unspecified disorder of optic computerized ophthalmic diagnostic imaging, 377.9 nerve and visual pathways posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 379.11 Scleral ectasia posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 379.12 Staphyloma posticum posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 379.13 Equatorial staphyloma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 379.14 Anterior staphyloma, localized posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 379.15 Ring staphyloma posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

63 Allow codes 92133, 92134; scanning Other degenerative disorders computerized ophthalmic diagnostic imaging, 379.16 of sclera posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 379.19 Other scleral disorder posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 379.21 Vitreous degeneration (PVD) posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Crystalline deposits in computerized ophthalmic diagnostic imaging, 379.22 vitreous posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 379.23 Vitreous hemorrhage posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Other vitreous opacities computerized ophthalmic diagnostic imaging, 379.24 (Floaters) posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Vitreous membranes and computerized ophthalmic diagnostic imaging, 379.25 strands posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 379.26 Vitreous prolapse posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 379.29 Other disorders of vitreous posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 743.20 Unspecified buphthalmos posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 743.21 Simple buphthalmos posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Buphthalmos associated with computerized ophthalmic diagnostic imaging, 743.22 other ocular anomalies posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning Specified congenital computerized ophthalmic diagnostic imaging, 743.57 anomalies of optic disc posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 743.58 Vascular anomalies posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

64 Allow codes 92133, 92134; scanning Other congenital anomalies of computerized ophthalmic diagnostic imaging, 743.59 posterior segment posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

Allow codes 92133, 92134; scanning computerized ophthalmic diagnostic imaging, 921.3 Contusion of eyeball posterior segment w/interpretation & report unilateral & bilateral; Optic Nerve or Retina

65