Local Coverage Determination (LCD): Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) (L34431)

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1 Local Coverage Determination (LCD): Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) (L34431) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor Name Contract Type Contract Number Jurisdiction State(s) Palmetto GBA A and B MAC MAC A J - J Alabama Palmetto GBA A and B MAC MAC A J - J Georgia Palmetto GBA A and B MAC MAC A J - J Tennessee Palmetto GBA A and B and HHH MAC MAC A J - M South Carolina Palmetto GBA A and B and HHH MAC MAC B J - M South Carolina Palmetto GBA A and B and HHH MAC MAC A J - M Virginia Palmetto GBA A and B and HHH MAC MAC B J - M Virginia Palmetto GBA A and B and HHH MAC MAC A J - M West Virginia Palmetto GBA A and B and HHH MAC MAC B J - M West Virginia Palmetto GBA A and B and HHH MAC MAC A J - M North Carolina Palmetto GBA A and B and HHH MAC MAC B J - M North Carolina Back to Top LCD Information Document Information LCD ID L34431 Original ICD-9 LCD ID L31562 Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 01/29/2018 LCD Title Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) Proposed LCD in Comment Period N/A Source Proposed LCD DL34431 AMA CPT / ADA CDT / AHA NUBC Copyright Statement Revision Ending Date 02/25/2018 Retirement Date N/A Notice Period Start Date 05/11/2017 Notice Period End Date 06/25/2017 Printed on 1/29/2018. Page 1 of 31

2 CPT only copyright American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright American Dental Association. All rights reserved. CDT and CDT-2016 are trademarks of the American Dental Association. UB-04 Manual. OFFICIAL UB-04 DATA SPECIFICATIONS MANUAL, 2014, is copyrighted by American Hospital Association ( AHA ), Chicago, Illinois. No portion of OFFICIAL UB-04 MANUAL may be reproduced, sorted in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior express, written consent of AHA. Health Forum reserves the right to change the copyright notice from time to time upon written notice to Company. CMS National Coverage Policy Title XVIII of the Social Security Act, 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Title XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. 42 CFR (a) indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements). CMS Internet-Only Manual, Pub , Medicare National Coverage Determinations Manual, Chapter 1, Part 1, 80.6 Intraocular Photography CMS Internet-Only Manual, Pub , Medicare National Coverage Determinations Manual, Chapter 1, Part 1, 80.9 Computer Enhanced Perimetry CMS Internet-Only Manual, Pub , Medicare National Coverage Determinations Manual, Chapter 1, Part 2, Laser Procedures Coverage Guidance Coverage Indications, Limitations, and/or Medical Necessity Background: Scanning computerized ophthalmic diagnostic imaging (SCODI) is a noninvasive, noncontact imaging technique that produces high resolution images of ocular structures. These high resolution images are used to provide qualitative and quantitative data about the structural or physiologic properties of structures in the anterior and posterior segment that have been validated as clinically useful in monitoring progression, resolution, or response to treatment of various ocular conditions involving the retina and optic nerve over time. Scanning computerized ophthalmic diagnostic imaging makes use of three distinct technologies to generate quantitative data: Printed on 1/29/2018. Page 2 of 31

3 confocal laser scanning ophthalmoscopy (CSLO) scanning laser polarimetry (SLO) optical coherence tomography (OCT) Examples of CSLO and SLO devices currently in use in clinical practice include the Heidelberg Laser Tomographic Scanner, Heidelberg Retinal Tomography (HRT), the GDx Nerve Fiber Analysis System, and the Retinal Thickness Analyzer (RTA). OCT is available from a number of manufacturers using one of two basic platforms, time domain (TD-OCT), such as the Visante anterior segment OCT, and the more widely used spectral, or Fourier, domain (SD/FD-OCT) such as the Spectralis, RTVue, Cirrus, and ivue. Although these techniques are different, their objective is the same. Medicare will consider scanning computerized ophthalmic diagnostic imaging (SCODI) medically reasonable and necessary in evaluating disorders of the anterior and posterior segment as documented in this local coverage determination (LCD). Posterior Segment Glaucoma is the second leading cause of blindness worldwide, and a disease for which effective treatment to slow or prevent progressive vision loss is available. However, glaucoma is diagnostically challenging and the majority of patients are asymptomatic early in the course of disease when the disease is most amenable to treatment. At the time of diagnosis, approximately 10-39% of patients have irrecoverable vision loss from advanced glaucoma. Elevated intraocular pressure is a clear risk factor for glaucoma, but over 40% of cases have pressures in the normal range while many other patients with abnormally high pressures do not suffer glaucomatous damage. Structural changes in the optic disc may not appear until a significant functional deficit (visual field loss) has occurred. There is no single diagnostic test that can be used exclusively to diagnose and monitor glaucoma. Diagnosis of glaucoma is made using an assemblage of data from tests that provide complementary assessments of the functional and structural status of the optic nerve. This often includes a comprehensive history and eye exam including visual acuity measurement, pupillary examination, intraocular pressure measurement, gonioscopy, anterior segment exam, fundoscopy, optic disc and retinal nerve fiber layer examination; and often confirmatory diagnostic tests including central corneal thickness measurement, visual field evaluation (preferably using automated perimetry), and quantitative imaging of the optic nerve head and retinal nerve fiber layer with stereoscopic disc photographs and scanning computerized ophthalmic diagnostic imaging. SCODI allows for early detection of glaucomatous damage to the retinal nerve fiber layer or optic disc and has demonstrated clinically utility in facilitating earlier diagnosis and treatment as well as monitoring for progression and response to treatment. SCODI also allows for differentiation and diagnosis of other disorders of the optic nerve as well as monitoring for progressive optic neuropathy and response to treatment in a number of neuro-ophthalmologic conditions. Retinal disorders are among the most common causes of severe and permanent vision loss. Scanning computerized ophthalmic diagnostic imaging (SCODI) is an invaluable tool for the evaluation and treatment of patients with retinal disease, particularly when there is macular involvement. SCODI is able to detail the microscopic anatomy of the retina, subretina, and vitreoretinal interface and provide information that has demonstrated evidence of superiority to other available techniques in a number of clinical studies. SCODI has demonstrated clinical utility in monitoring patients with retinal diseases for progression which is critical for judging a response to or need for treatment of a number of retinal conditions. SCODI has been validated for use in ongoing screening for drug-related ocular toxicity due to its ability to detect early photoreceptor damage in patients taking certain high-risk drugs. The use of SCODI should be performed according to the most current recommended guidelines. The current recommendations for monitoring patients taking chloroquine or hydroxychloroquine include 1) a baseline exam within the first year of commencement which should include a SD-OCT if any macular abnormalities are present, and, 2) annual screening beginning at the 5th year of exposure in patients who are on a dose Anterior Segment There are numerous reports in the literature detailing the potential applications of anterior segment optical coherence tomography (AS-OCT and SD-OCT with anterior segment imaging capabilities) to image and provide measurements of anterior segment structures in a number of clinical situations. The current literature consists primarily of qualitative and quantitative imaging and detection capabilities, though there remains a lack of consensus on the sensitivity, specificity, and predictive value of anterior segment OCT in the vast majority of anterior segment applications and no endorsement of its use over gonioscopy or ultrasound biomicroscopy. The strongest evidence in support of the clinical utility of anterior segment OCT lies in its ability to image the structures of the anterior chamber angle, particularly in narrow angles. Current recommended practice patterns Printed on 1/29/2018. Page 3 of 31

4 by the American Academy of Ophthalmology endorse gonioscopy as the preferred means of performing evaluation of the anterior chamber angle. Although there remains insufficient evidence to endorse anterior segment OCT as a substitute for gonioscopy, anterior segment OCT is a recommended option in cases where angle closure is suspected and the angle anatomy is not conducive to gonioscopic assessment. Indications and Limitations: SCODI Anterior Segment Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral. Anterior segment OCT is considered reasonable and necessary when ordered for the evaluation of narrow angle, suspected narrow angle, and mixed mechanism glaucoma: In patients who are unable to undergo gonioscopy due to cognitive or physical limitations. When anatomic features, corneal opacity, or corneal edema preclude gonioscopic visualization. Indications other than those stipulated in this LCD are considered investigational and are not covered. SCODI is not covered for screening. SCODI is not covered in the absence of an indication. It is expected that no more than two (2) anterior segment OCT tests per year would be indicated in evaluating patients with a diagnosis of angle closure suspect, narrow angles, angle closure, and mixed mechanism glaucoma without a significant change in clinical status. It is expected that no more than 1 (1) AS-OCT test per three (3) years would be indicated in evaluating patients with all forms of open angle glaucoma including glaucoma suspect, ocular hypertension, secondary glaucoma, and congenital glaucoma. SCODI Optic Nerve Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve. SCODI of the optic disc (92133) is considered reasonable and necessary when ordered to: Aid in the early diagnosis of glaucoma and monitor for progression and response to treatment. Monitor glaucoma suspect patients for evidence of glaucomatous change. Detect further loss of optic nerve or retinal nerve fiber layer tissue to aid in monitoring for progression in advanced optic nerve damage and advanced visual field loss. Differentiate when there is a discrepancy between the clinical appearance of the optic nerve and the visual field. Provide additional information to facilitate diagnosis and management when visual field results are insufficient or cannot be performed due to visual, mental, physical, or age limitations of the patient. Differentiate causes of other optic nerve disorders when a diagnosis is in doubt. Aid in the diagnosis and management of other optic nerve disorders and neuro-ophthalmologic diseases involving changes in the optic nerve head and retinal nerve fiber layer. SCODI is not covered when used for screening. SCODI is not covered in the absence of an indication. SCODI (92133, 92134) and fundus photography (92250) are mutually exclusive codes. However, there may be a limited number of clinical situations in which it is necessary to perform both techniques in order to evaluate and treat the patient. In these situations, both CPT codes may be reported appending modifier 59 to indicate a distinct procedural service. Documentation supportive of the need to perform both techniques should be clear in the medical record. Printed on 1/29/2018. Page 4 of 31

5 It is expected that no more than one (1) SCODI test per year would be indicated in monitoring patients with glaucoma suspect without a significant change in clinical status. It is expected that no more than two (2) SCODI tests per year would be indicated in monitoring patients with progressive optic neuropathies, including glaucoma (mild, moderate, severe, and indeterminate) without a significant change in clinical status. Advancements in scanning computerized ophthalmic diagnostic imaging technologies have increased the utility of these devices in both the diagnosis of glaucoma and detection of glaucomatous progression. Hardware and software limitations can impact the reliability of these tests in more advanced cases of glaucoma particularly once the floor effect is reached whereby the ability to discern and measure thickness of the remaining neural tissue limits the ability to detect progression. The use of SCODI in advanced glaucoma is covered provided the hardware and software utilized continues to provide clinically meaningful measurements that allow for the detection of progression. SCODI Retina Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina. SCODI of the retina (92134) is considered reasonable and necessary when ordered to: Aid in the diagnosis and management of retinal conditions which involve changes in the subretinal, intraretinal, and vitreoretinal relationships. Monitor for progression or resolution of conditions in order to determine the need for or response to treatment. Monitor for evidence of ocular toxicity in patients taking high risk drugs with a known potential for causing toxic retinopathy. SCODI is not covered when used for screening. SCODI is not covered in the absence of an indication. SCODI should only be performed at clinically reasonable intervals (i.e., consistent with a noted change in clinical status or after sufficient time has elapsed to assess for progression or response to treatment). It is generally expected that conditions requiring more aggressive treatment and monitoring due to changing clinical status or treatment interventions will generally not require SCODI testing more than one (1) per month. Current recommendations for monitoring patients taking chloroquine or hydroxychloroquine who are on a dose Summary of Evidence N/A Analysis of Evidence (Rationale for Determination) N/A Back to Top Coding Information Bill Type Codes: Printed on 1/29/2018. Page 5 of 31

6 Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. N/A Revenue Codes: Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes. N/A CPT/HCPCS Codes Group 1 Paragraph: N/A Group 1 Codes: SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, ANTERIOR SEGMENT, WITH INTERPRETATION AND REPORT, UNILATERAL OR BILATERAL SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, WITH INTERPRETATION AND REPORT, UNILATERAL OR BILATERAL; OPTIC NERVE SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, WITH INTERPRETATION AND REPORT, UNILATERAL OR BILATERAL; RETINA ICD-10 Codes that Support Medical Necessity Group 1 Paragraph: The use of one code from both Group 1 and Group 2 should be selected when billing for In the event the coding does not adequately describe the specific patient circumstances precluding gonioscopic assessment of the anterior chamber angle which necessitate anterior segment OCT, supporting documentation should be clearly documented in the medical record. Group 1 Codes: ICD-10 Codes A18.59 Other tuberculosis of eye H17.01 Adherent leukoma, right eye H17.02 Adherent leukoma, left eye H17.03 Adherent leukoma, bilateral H17.11 Central corneal opacity, right eye H17.12 Central corneal opacity, left eye H17.13 Central corneal opacity, bilateral H Minor opacity of cornea, right eye H Minor opacity of cornea, left eye H Minor opacity of cornea, bilateral H Peripheral opacity of cornea, right eye H Peripheral opacity of cornea, left eye H Peripheral opacity of cornea, bilateral H17.89 Other corneal scars and opacities H17.9 Unspecified corneal scar and opacity H18.11 Bullous keratopathy, right eye H18.12 Bullous keratopathy, left eye H18.13 Bullous keratopathy, bilateral H18.20 Unspecified corneal edema H Corneal edema secondary to contact lens, right eye H Corneal edema secondary to contact lens, left eye H Corneal edema secondary to contact lens, bilateral H Idiopathic corneal edema, right eye Printed on 1/29/2018. Page 6 of 31

7 ICD-10 Codes H Idiopathic corneal edema, left eye H Idiopathic corneal edema, bilateral H21.82 Plateau iris syndrome (post-iridectomy) (postprocedural) Q13.1 Absence of iris Group 2 Paragraph: The use of one code from both Group 1 and Group 2 should be selected when billing for In the event the coding does not adequately describe the specific patient circumstances precluding gonioscopic assessment of the anterior chamber angle which necessitate anterior segment OCT, supporting documentation should be clearly documented in the medical record. Group 2 Codes: ICD-10 Codes H Secondary corneal edema, right eye H Secondary corneal edema, left eye H Secondary corneal edema, bilateral H Degeneration of iris (pigmentary), right eye H Degeneration of iris (pigmentary), left eye H Degeneration of iris (pigmentary), bilateral H21.41 Pupillary membranes, right eye H21.42 Pupillary membranes, left eye H21.43 Pupillary membranes, bilateral H Goniosynechiae, right eye H Goniosynechiae, left eye H Goniosynechiae, bilateral H Recession of chamber angle, right eye H Recession of chamber angle, left eye H Recession of chamber angle, bilateral H Preglaucoma, unspecified, right eye H Preglaucoma, unspecified, left eye H Preglaucoma, unspecified, bilateral H Open angle with borderline findings, low risk, right eye H Open angle with borderline findings, low risk, left eye H Open angle with borderline findings, low risk, bilateral H Open angle with borderline findings, high risk, right eye H Open angle with borderline findings, high risk, left eye H Open angle with borderline findings, high risk, bilateral H Anatomical narrow angle, right eye H Anatomical narrow angle, left eye H Anatomical narrow angle, bilateral H Steroid responder, right eye H Steroid responder, left eye H Steroid responder, bilateral H Ocular hypertension, right eye H Ocular hypertension, left eye H Ocular hypertension, bilateral H Primary angle closure without glaucoma damage, right eye H Primary angle closure without glaucoma damage, left eye H Primary angle closure without glaucoma damage, bilateral H40.10X1 Unspecified open-angle glaucoma, mild stage H40.10X2 Unspecified open-angle glaucoma, moderate stage H40.10X3 Unspecified open-angle glaucoma, severe stage H40.10X4 Unspecified open-angle glaucoma, indeterminate stage H Primary open-angle glaucoma, right eye, stage unspecified H Primary open-angle glaucoma, right eye, mild stage Printed on 1/29/2018. Page 7 of 31

8 ICD-10 Codes H Primary open-angle glaucoma, right eye, moderate stage H Primary open-angle glaucoma, right eye, severe stage H Primary open-angle glaucoma, right eye, indeterminate stage H Primary open-angle glaucoma, left eye, stage unspecified H Primary open-angle glaucoma, left eye, mild stage H Primary open-angle glaucoma, left eye, moderate stage H Primary open-angle glaucoma, left eye, severe stage H Primary open-angle glaucoma, left eye, indeterminate stage H Primary open-angle glaucoma, bilateral, stage unspecified H Primary open-angle glaucoma, bilateral, mild stage H Primary open-angle glaucoma, bilateral, moderate stage H Primary open-angle glaucoma, bilateral, severe stage H Primary open-angle glaucoma, bilateral, indeterminate stage H Low-tension glaucoma, right eye, mild stage H Low-tension glaucoma, right eye, moderate stage H Low-tension glaucoma, right eye, severe stage H Low-tension glaucoma, right eye, indeterminate stage H Low-tension glaucoma, left eye, mild stage H Low-tension glaucoma, left eye, moderate stage H Low-tension glaucoma, left eye, severe stage H Low-tension glaucoma, left eye, indeterminate stage H Low-tension glaucoma, bilateral, mild stage H Low-tension glaucoma, bilateral, moderate stage H Low-tension glaucoma, bilateral, severe stage H Low-tension glaucoma, bilateral, indeterminate stage H Pigmentary glaucoma, right eye, mild stage H Pigmentary glaucoma, right eye, moderate stage H Pigmentary glaucoma, right eye, severe stage H Pigmentary glaucoma, right eye, indeterminate stage H Pigmentary glaucoma, left eye, mild stage H Pigmentary glaucoma, left eye, moderate stage H Pigmentary glaucoma, left eye, severe stage H Pigmentary glaucoma, left eye, indeterminate stage H Pigmentary glaucoma, bilateral, mild stage H Pigmentary glaucoma, bilateral, moderate stage H Pigmentary glaucoma, bilateral, severe stage H Pigmentary glaucoma, bilateral, indeterminate stage H Capsular glaucoma with pseudoexfoliation of lens, right eye, mild stage H Capsular glaucoma with pseudoexfoliation of lens, right eye, moderate stage H Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage H Capsular glaucoma with pseudoexfoliation of lens, right eye, indeterminate stage H Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stage H Capsular glaucoma with pseudoexfoliation of lens, left eye, moderate stage H Capsular glaucoma with pseudoexfoliation of lens, left eye, severe stage H Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stage H Capsular glaucoma with pseudoexfoliation of lens, bilateral, moderate stage H Capsular glaucoma with pseudoexfoliation of lens, bilateral, severe stage H Capsular glaucoma with pseudoexfoliation of lens, bilateral, indeterminate stage H Residual stage of open-angle glaucoma, right eye H Residual stage of open-angle glaucoma, left eye H Residual stage of open-angle glaucoma, bilateral H40.20X1 Unspecified primary angle-closure glaucoma, mild stage H40.20X2 Unspecified primary angle-closure glaucoma, moderate stage H40.20X3 Unspecified primary angle-closure glaucoma, severe stage H40.20X4 Unspecified primary angle-closure glaucoma, indeterminate stage H Acute angle-closure glaucoma, right eye H Acute angle-closure glaucoma, left eye H Acute angle-closure glaucoma, bilateral Printed on 1/29/2018. Page 8 of 31

9 ICD-10 Codes H Chronic angle-closure glaucoma, right eye, mild stage H Chronic angle-closure glaucoma, right eye, moderate stage H Chronic angle-closure glaucoma, right eye, severe stage H Chronic angle-closure glaucoma, right eye, indeterminate stage H Chronic angle-closure glaucoma, left eye, mild stage H Chronic angle-closure glaucoma, left eye, moderate stage H Chronic angle-closure glaucoma, left eye, severe stage H Chronic angle-closure glaucoma, left eye, indeterminate stage H Chronic angle-closure glaucoma, bilateral, mild stage H Chronic angle-closure glaucoma, bilateral, moderate stage H Chronic angle-closure glaucoma, bilateral, severe stage H Chronic angle-closure glaucoma, bilateral, indeterminate stage H Intermittent angle-closure glaucoma, right eye H Intermittent angle-closure glaucoma, left eye H Intermittent angle-closure glaucoma, bilateral H Residual stage of angle-closure glaucoma, right eye H Residual stage of angle-closure glaucoma, left eye H Residual stage of angle-closure glaucoma, bilateral H40.31X1 Glaucoma secondary to eye trauma, right eye, mild stage H40.31X2 Glaucoma secondary to eye trauma, right eye, moderate stage H40.31X3 Glaucoma secondary to eye trauma, right eye, severe stage H40.31X4 Glaucoma secondary to eye trauma, right eye, indeterminate stage H40.32X1 Glaucoma secondary to eye trauma, left eye, mild stage H40.32X2 Glaucoma secondary to eye trauma, left eye, moderate stage H40.32X3 Glaucoma secondary to eye trauma, left eye, severe stage H40.32X4 Glaucoma secondary to eye trauma, left eye, indeterminate stage H40.33X1 Glaucoma secondary to eye trauma, bilateral, mild stage H40.33X2 Glaucoma secondary to eye trauma, bilateral, moderate stage H40.33X3 Glaucoma secondary to eye trauma, bilateral, severe stage H40.33X4 Glaucoma secondary to eye trauma, bilateral, indeterminate stage H40.41X1 Glaucoma secondary to eye inflammation, right eye, mild stage H40.41X2 Glaucoma secondary to eye inflammation, right eye, moderate stage H40.41X3 Glaucoma secondary to eye inflammation, right eye, severe stage H40.41X4 Glaucoma secondary to eye inflammation, right eye, indeterminate stage H40.42X1 Glaucoma secondary to eye inflammation, left eye, mild stage H40.42X2 Glaucoma secondary to eye inflammation, left eye, moderate stage H40.42X3 Glaucoma secondary to eye inflammation, left eye, severe stage H40.42X4 Glaucoma secondary to eye inflammation, left eye, indeterminate stage H40.43X1 Glaucoma secondary to eye inflammation, bilateral, mild stage H40.43X2 Glaucoma secondary to eye inflammation, bilateral, moderate stage H40.43X3 Glaucoma secondary to eye inflammation, bilateral, severe stage H40.43X4 Glaucoma secondary to eye inflammation, bilateral, indeterminate stage H40.51X1 Glaucoma secondary to other eye disorders, right eye, mild stage H40.51X2 Glaucoma secondary to other eye disorders, right eye, moderate stage H40.51X3 Glaucoma secondary to other eye disorders, right eye, severe stage H40.51X4 Glaucoma secondary to other eye disorders, right eye, indeterminate stage H40.52X1 Glaucoma secondary to other eye disorders, left eye, mild stage H40.52X2 Glaucoma secondary to other eye disorders, left eye, moderate stage H40.52X3 Glaucoma secondary to other eye disorders, left eye, severe stage H40.52X4 Glaucoma secondary to other eye disorders, left eye, indeterminate stage H40.53X1 Glaucoma secondary to other eye disorders, bilateral, mild stage H40.53X2 Glaucoma secondary to other eye disorders, bilateral, moderate stage H40.53X3 Glaucoma secondary to other eye disorders, bilateral, severe stage H40.53X4 Glaucoma secondary to other eye disorders, bilateral, indeterminate stage H40.61X1 Glaucoma secondary to drugs, right eye, mild stage H40.61X2 Glaucoma secondary to drugs, right eye, moderate stage H40.61X3 Glaucoma secondary to drugs, right eye, severe stage H40.61X4 Glaucoma secondary to drugs, right eye, indeterminate stage Printed on 1/29/2018. Page 9 of 31

10 ICD-10 Codes H40.62X1 Glaucoma secondary to drugs, left eye, mild stage H40.62X2 Glaucoma secondary to drugs, left eye, moderate stage H40.62X3 Glaucoma secondary to drugs, left eye, severe stage H40.62X4 Glaucoma secondary to drugs, left eye, indeterminate stage H40.63X1 Glaucoma secondary to drugs, bilateral, mild stage H40.63X2 Glaucoma secondary to drugs, bilateral, moderate stage H40.63X3 Glaucoma secondary to drugs, bilateral, severe stage H40.63X4 Glaucoma secondary to drugs, bilateral, indeterminate stage H Glaucoma with increased episcleral venous pressure, right eye H Glaucoma with increased episcleral venous pressure, left eye H Glaucoma with increased episcleral venous pressure, bilateral H Hypersecretion glaucoma, right eye H Hypersecretion glaucoma, left eye H Hypersecretion glaucoma, bilateral H Aqueous misdirection, right eye H Aqueous misdirection, left eye H Aqueous misdirection, bilateral H40.89 Other specified glaucoma H42 Glaucoma in diseases classified elsewhere Q15.0 Congenital glaucoma Group 3 Paragraph: Group 3 Codes: ICD-10 Codes A18.53 Tuberculous chorioretinitis B39.4 Histoplasmosis capsulati, unspecified B39.5 Histoplasmosis duboisii B39.9 Histoplasmosis, unspecified C69.31 Malignant neoplasm of right choroid C69.32 Malignant neoplasm of left choroid D31.31 Benign neoplasm of right choroid D31.32 Benign neoplasm of left choroid E Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema E Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema E Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye E Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye E Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral E Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye E Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye E Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral E Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye E Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye E Printed on 1/29/2018. Page 10 of 31

11 ICD-10 Codes Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral E Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye E Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye E Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral E Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye E Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye E Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral E Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, right eye E Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye E Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral E Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye E Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye E Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye E Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral E08.37X1 Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye E08.37X2 Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, left eye E08.37X3 Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, bilateral E Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema Printed on 1/29/2018. Page 11 of 31

12 ICD-10 Codes E Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema E Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye E Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye E Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral E Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye E Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye E Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral E Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye E Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye E Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral E Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye E Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye E Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral E Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye E Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye E Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral E Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye E Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye E Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye E Printed on 1/29/2018. Page 12 of 31

13 ICD-10 Codes Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral E Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye E Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye E Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral E09.37X1 Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye E09.37X2 Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, left eye E09.37X3 Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral E Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema E Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral E Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye Printed on 1/29/2018. Page 13 of 31

14 ICD-10 Codes E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral E Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral E Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye E Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye E Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral E Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral E10.37X1 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye E10.37X2 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye E10.37X3 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral E Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema E Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral Printed on 1/29/2018. Page 14 of 31

15 ICD-10 Codes E Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral E Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral E Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye E Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye E Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral E Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral E11.37X1 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye E11.37X2 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye E11.37X3 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral E Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema E Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye Printed on 1/29/2018. Page 15 of 31

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