ELECTRORETINOGRAPHY OTH903.006 ______________________________________________________________________ COVERAGE: The importance of electroretinography is in the evaluation of generalized retinal disease. Examples may include: · retinitis pigmentosa (progressive degeneration of photoreceptor cells); · massive ischemia; · toxic effects from drugs or chemicals (e.g. iron intraocular foreign body); · congenital retinal dystrophies (retina may appear normal by ophthalmoscopy); · disseminated infection. Coverage will be allowed for this procedure based on the guidelines. ______________________________________________________________________ DESCRIPTION: Electroretinography is one method of evaluating the neurologic integrity of the visual pathway. It measures the normal change in electrical potential of the eye caused by a diffuse flash of light. Following a light stimulus, an electrode (placed on the cornea by means of a special contact lens) detects the change in electrical potential and records it as a single, composite oscilloscope wave form. This is called the electroretinography or ERG. ______________________________________________________________________ RATIONALE: None ______________________________________________________________________ DISCLAIMER: State and federal law, as well as contract language, including definitions and specific inclusions/exclusions, takes precedence over Medical Policy and must be considered first in determining coverage. The member’s contract benefits in effect on the date that services are rendered must be used. Any benefits are subject to the payment of premiums for the date on which services are rendered. Medical technology is constantly evolving, and we reserve the right to review and update Medical Policy periodically. HMO Blue Texas physicians who are contracted/affiliated with a capitated IPA/medical group must contact the IPA/medical group for information regarding HMO claims/reimbursement information and other general polices and procedures. ______________________________________________________________________ Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company* Southwest Texas HMO, Inc.* d/b/a HMO BlueÒ Texas * Independent Licensees of the Blue Cross and Blue Shield Association ______________________________________________________________________ Posted Jan. 7, 2003.