Clinical Policy Title: Therapeutic contact lenses Clinical Policy Number: 10.02.02 Effective Date: June 1, 2014 Initial Review Date: December 18, 2013 Most Recent Review Date: January 11, 2018 Next Review Date: January 2019 Related policies: Policy contains: Hydrophilic contact lens for corneal bandage. Boston scleral lens. Scleral shell lens. Amniotic membrane transplantation. CP# 10.03.04 CP# 10.03.06 Corneal transplants (keratoplasty) Corneal implants ABOUT THIS POLICY: Select Health of South Carolina has developed clinical policies to assist with making coverage determinations. Select Health of South Carolina s clinical policies are based on guidelines from established industry sources, such as the Centers for Medicare & Medicaid Services (CMS), state regulatory agencies, the American Medical Association (AMA), medical specialty professional societies, and peer-reviewed professional literature. These clinical policies along with other sources, such as plan benefits and state and federal laws and regulatory requirements, including any state- or plan-specific definition of medically necessary, and the specific facts of the particular situation are considered by Select Health of South Carolina when making coverage determinations. In the event of conflict between this clinical policy and plan benefits and/or state or federal laws and/or regulatory requirements, the plan benefits and/or state and federal laws and/or regulatory requirements shall control. Select Health of South Carolina s clinical policies are for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other health care providers are solely responsible for the treatment decisions for their patients. Select Health of South Carolina s clinical policies are reflective of evidence-based medicine at the time of review. As medical science evolves, Select Health of South Carolina will update its clinical policies as necessary. Select Health of South Carolina s clinical policies are not guarantees of payment. Coverage policy Select Health of South Carolina considers the use of therapeutic contact lenses to be clinically proven and, therefore, medically necessary when all of the following criteria are met (American Academy of Ophthalmology [AAO], 2017; Watson, 2012; Foulks, 2003): Use of any of the following lens types: Contact lenses or intra-ocular lenses placed after cataract surgery, as they are considered prostheses unless otherwise specified by the member s benefit plan. Hydrophilic soft contact lenses or gas-permeable fluid ventilated scleral lenses, when used in the management of severe corneal disease. Boston scleral lens when used as a moist corneal bandage if lubricants or drops are not appropriate. Scleral shell contact lenses for the treatment of severe keratoconjunctivitis sicca and/or when the orbit requires greater support because of the loss of corneal strength. Any of the following functional impairments are being corrected: Not able to achieve vision of 20/40 or better, despite best correction with eyeglasses or typical contact lenses. 1
Lenses will delay/prevent the need for corneal transplantation. Will improve performance of activities of daily living. Select Health of South Carolina Pennsylvania considers the use of amniotic membrane transplantation to be clinically proven and, therefore, medically necessary on a case-by-case basis for certain circumstances where there is a severe condition requiring acute treatment, such as (Zhao, 2015; Clare, 2012): Limitations: Chemical, thermal, or radiation injuries. Stevens Johnson Syndrome. Limbal stem cell failure. All other uses of therapeutic contact lenses are not medically necessary. Contact lenses for vision correction are subject to benefit plans of the individual member. The use of contact lenses for treatment of visual perceptual dysfunction, such as dyslexia, has not had consistent results in clinical studies and cannot be considered medically necessary. For Medicare members only: For services performed on or after October 1, 2015, amniotic membrane transplantation for ocular conditions will be considered medically reasonable and necessary for the following indications (L36237): Failure of standard therapy for severe ophthalmological conditions demonstrated by ocular surface cell damage or failure and/or underlying inflammation, scarring, or ulceration of the underlying stroma. There may be circumstances where there is a severe condition requiring acute treatment with amniotic membrane, such as: Chemical, thermal or radiation injuries. Stevens Johnson Syndrome. Limbal stem cell failure. Band keratopathy after treatment with other therapy, such as: Surgery. Topical medications Bandage contact lens. Patching. Bullous keratopathy associated with an epithelial defect. Scleral melting. Corneal ulcer following initiation of anti-infective therapy and demonstration of clinical response for the purpose of healing the persistent epithelial defect. Chemical burns of the ocular surface. Conjunctival defects after treatment with other therapy, such as surgery or topical medications. 2
Corneal melting. Limbal stem cell deficiency. Recurrent corneal erosions after treatment failure with other therapy, such as: Bandage contact lens. Patching. Topical medications. Limitations for Medicare members only: Amniotic membrane must have U.S. Food and Drug Administration (FDA) approval for sutureless applications to eye. Application for dry eye syndrome is not medically necessary, given no demonstrated impact on long-term outcome. Cogan s Dystrophy is not covered unless associated with corneal epithelial removal. Alternative covered services: Physician office visits. Standard covered ocular surgery. Standard medical management of corneal disease. Background Corneal pathology may cause correctable vision distortion, pain, or threaten sight. Vision may be corrected by the use of refractive eyeglasses or contact lenses. These lenses are primarily used for correction of myopia, hypermetropia, astigmatism, and presbyopia, and as such, are a cosmetic substitute for eyeglasses. Refracting contact lenses may be rigid/hard lens, soft (hydrophilic, hydrogel and silicone hydrogel) or gas permeable rigid lens. Therapeutic contact lenses are designed to manage other ocular pathology beyond simple refractive disorders. There are several types of therapeutic lenses available for the management of these disorders, consisting of: Corneal liquid bandage lens may be rigid gas permeable scleral contact lenses or a therapeutic contact lens. They are used to treat acute or chronic corneal disease, such as the persistent epithelial defects listed above. These lenses protect the cornea from the drying effects of air and may reduce pain and photophobia. Because such lenses cover the entire cornea with a smooth surface, they may improve vision that results from acute astigmatism. Boston scleral lens was developed through the Boston Foundation for Sight. It is a specially designed fluid-ventilated, gas-permeable contact lens. The design allows a bubble-free reservoir of oxygenated aqueous fluid to cover the corneal surface, at a neutral hydrostatic 3
pressure. This design makes it well suited for severe corneal diseases. Scleral shell contact lens covers the entire exposed surface of the eye. For individuals with severe dry eye, such as keratoconjunctivitis, the scleral shell lens can hold artificial tears that have been dropped into the eye. These lenses protect the eye against further drying. The scleral shell also allows support and protection when severe corneal disease has rendered the person blind. Use of the scleral shell may prevent enucleation by providing support for the rest of the eye. Amniotic membrane transplantation is performed in cases of severe thermal or chemical burns to the cornea to reduce pain and accelerate healing. Searches Select Health of South Carolina searched PubMed and the databases of: UK National Health Services Centre for Reviews and Dissemination. Agency for Healthcare Research and Quality s National Guideline Clearinghouse and other evidence-based practice centers. The Centers for Medicare & Medicaid Services (CMS). We conducted searches on November 21, 2017. Search terms were: "Contact Lenses/therapeutic use"(mesh), "Contact Lenses, Extended-Wear/therapeutic use"(mesh), therapeutic contact lenses, and amniotic membrane. We included: Systematic reviews, which pool results from multiple studies to achieve larger sample sizes and greater precision of effect estimation than in smaller primary studies. Systematic reviews use predetermined transparent methods to minimize bias, effectively treating the review as a scientific endeavor, and are thus rated highest in evidence-grading hierarchies. Guidelines based on systematic reviews. Economic analyses, such as cost-effectiveness, and benefit or utility studies (but not simple cost studies), reporting both costs and outcomes sometimes referred to as efficiency studies which also rank near the top of evidence hierarchies. Findings Most studies on the various medical uses of contact lenses have been single site, with relatively small numbers enrolled. We found no recent meta-analyses of therapeutic contact lenses or head-to-head comparisons between the various products. Reviews of studies of amniotic membrane transplantation have not found sufficient evidence from published, peer-reviewed articles to support its routine use (Clare, 2012; Hayes, 2013). Professional guidelines note the absence of such studies and recommend that the professional describe the advantages of various strategies, thus allowing the patient to be an active participant in the clinical 4
judgment (AAO, 2017). There is consensus that patients with corneal pathology that threatens to weaken the architecture of the eye should be treated with appropriate medical therapy and/or supporting contact lenses. The corneal disorders for which contact lenses may become therapeutic include the following conditions: Policy updates: Aphakia. Prostheses following cataract surgery. Stevens-Johnson syndrome, toxic epidermolysis necrosis, chemical burns, or other corneal stem cell deficiencies. Congenital anomalies. Neurotrophic corneas. Keratoconjunctivitis with reduced tear production. Corneal involvement of systemic autoimmune disorders. Corneal exposure disorders. Epidermal ocular disorders. Keratoconus associated with irregular astigmatism. We found one new systematic review that addressed ex vivo cultured limbal epithelial transplantation with amniotic membrane transplantation for the treatment of limbal stem cell deficiency (Zhao, 2015). We found one ongoing clinical trial of amniotic membrane transplantation that has been in progress since the year 2000, but has not been verified since 2008, and no published results of the study are available (ClinicalTrials.gov identifier: NCT00344708). Since the last review date of this policy, the AAO has updated three Preferred Practice Pattern guidelines: corneal edema and opacification; corneal ectasia; and dry eye syndrome (AAO, 2015a, 2015b, and 2015c). The new information does not impact the results of the original clinical policy. Therefore, no changes to the policy are warranted. In 2018, we added the results of a Cochrane review (Clearfield, 2016) and updated, consolidated guidance from the AAO (2017). Clearfield et al found that conjunctival autograft surgery was associated with a lower risk of pterygium recurrence at six months compared to amniotic membrane transplantation, but additional research is needed to determine which type of surgery resulted in better vision or quality of life. The AAO (2017) guidance has not changed. No policy changes are warranted at this time. Summary of clinical evidence: Citation AAO (2017) Content, Methods, Recommendations Key points: Summary Benchmarks for Preferred Practice Pattern Guidelines For corneal ectasia, rigid gas permeable contact lenses can mask corneal irregularities. New hybrid contact lenses provide higher oxygen permeability and greater rigid gas permeable /hydrogel junction strength. Piggyback contact lenses may be employed in cases of corneal scaring or decentered cones. Scleral lenses may be indicated when rigid gas permeable and/or hybrid contact lenses fail. 5
Citation Clearfield (2016) Conjunctival autograft for pterygium Cochrane review Zhao (2015) Amniotic membrane transplantation for treatment of limbal stem cell deficiency Clare (2012) Cochrane review Amniotic membrane transplantation Watson (2012) Content, Methods, Recommendations For corneal opacification, a bandage contact lens may be useful in cases of delayed healing. For corneal opacification, A rigid gas permeable lens or hybrid or scleral lens when greater stability is needed will often improve vision when surface irregularity is a factor; such lenses may preclude the need for more invasive procedures. Key points: Systematic review and meta-analysis of 20 RCTs (1,947 eyes of 1,866 total participants) from multiple countries comparing conjunctival autograft versus amniotic membrane transplantation. Overall quality: low with unclear risk of bias for most studies. In association with pterygium excision, conjunctival autograft is associated with a lower risk of recurrence after surgery than amniotic membrane transplant at 6 months (risk ratio [RR] 0.53, 95% confidence interval [CI] 0.33 to 0.85). These estimates include participants with primary and recurrent pterygia. - For participants with primary and recurrent pterygium only, RR of pterygium recurrence at 6 months' follow-up was 0.43 (95% CI 0.30 to 0.62). Insufficient evidence to assess need for repeat surgery, visual acuity outcomes, vision-related quality of life, and direct and indirect costs of surgery, or to estimate the effects of adjunctive mitomycin C on pterygium recurrence following either procedure. Adverse events associated with both procedures that occurred in more than one study were granuloma and pyogenic granuloma and increased intraocular pressure. None of the included studies reported that participants had developed induced astigmatism (13 total studies reporting). Key points: Systematic review of 18 articles involving 572 eyes of 562 patients who underwent ex vivo cultured limbal epithelial transplantation. The rate of success and 2-line improvement in best corrected visual acuity (BCVA) was 67% (95% CI 0.59 to 0.75; I = 60%) and 62% (95% CI 0.57 to 0.66; I = 37.7%), respectively; and no difference was found either in success rate (odds ratio [OR] 1.35, 95% CI 0.63 to 2.89; I = 46%) or visual acuity (VA) outcome (OR 1.53, 95% CI 0.67 to 3.45; I = 42.1%) between autograft and allograft. Cultured limbal epithelial transplantation appears efficacious in patients with limbal stem cell deficiency. Acceptable safety profile with most side effects being transient and amenable to subsequent treatments. Long-term results of autograft and allograft are needed to inform future treatment algorithms and techniques with RCTs and better-designed analysis. Key points: Systematic review found one RCT with 100 participants with ocular burns, comparing standard treatment to amniotic membrane transplantation. The study was flawed in that the control group had worse acuity at the start than did the amniotic membrane transplantation group. But the latter had better vision at the end. There is inadequate evidence supporting the treatment of ocular surface burns with amniotic membrane transplantation. Key points: 6
Citation Management of recurrent corneal erosion Content, Methods, Recommendations Meta-analysis of seven RCTs and one quasi-rct. These various studies came to different independent conclusions regarding use of oral tetracycline, contact lenses or hypertonic saline ointment. The therapeutic contact lens arm had older rigid lenses and was less able to reduce pain or promote healing, compared to the oral tetracycline or hypertonic saline ointment. References Professional society guidelines/other: American Academy of Ophthalmology. Preferred Practice Pattern Panels. Summary Benchmarks Full Set 2016. Jun 2017. AAO website. https://www.aao.org/summary-benchmark-detail/summary-benchmarksfull-set-2016. Accessed November 21, 2017. American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities, AAO, American Association for Pediatric Ophthalmology and Strabismus and American Association of Certified Orthoptists. Learning Disabilities, Dyslexia, and Vision. Pediatrics 2009 Aug; 124(2); 837 844. Also available at: http://pediatrics.aappublications.org/content/124/2/837.long. Accessed November 21, 2017. Peer-reviewed references: Clare G, Suleman H, Bunce C, Dua H. Amniotic membrane transplantation for acute ocular burns. Cochrane Database Syst Rev. 2012 Sep 12; 9: CD009379. DOI: 10.1002/14651858.CD009379.pub2. Clearfield E, Muthappan V, Wang X, Kuo IC. Conjunctival autograft for pterygium. Cochrane Database Syst Rev. 2016; 2: Cd011349. DOI: 10.1002/14651858.CD011349.pub2. Foulks GN, Harvey T, Raj CV. Therapeutic contact lenses: the role of high-dk lenses. Ophthalmol Clin North Am. 2003 Sep; 16(3): 455 461. Hayes Inc. Hayes Medical Technology Report. Boston Equalens Scleral Contact Lens (Polymer Technology Corp.) for Severe Ocular Surface Disease. Lansdale, Pa: Hayes Inc.; October, 2006. [Archived 2009]. Szczotka-Flynn L, Diaz M. Risk of corneal inflammatory events with silicone hydrogel and low dk hydrogel extended contact lens wear: a meta-analysis. Optom. Vis Sci. 2007 Apr; 84(4): 247 256. DOI: 10.1097/OPX.0b013e3180421c47. Watson SL, Lee MH, Barker NH. Interventions for recurrent corneal erosions. Cochrane Database of Sys Rev. 2012; 9: CD001861. DOI: 10.1002/14651858.CD001861.pub3. Zhao Y, Ma L. Systematic review and meta-analysis on transplantation of ex vivo cultivated limbal epithelial stem cell on amniotic membrane in limbal stem cell deficiency. Cornea. 2015; 34(5): 592 600. DOI: 7
10.1097/ico.0000000000000398. CMS National Coverage Determinations (NCDs): 80.1 Hydrophilic Contact Lens for Corneal Bandage. CMS website. http://cms.hhs.gov/medicare-coveragedatabase/details/ncd-details.aspx?ncdid=136&ncdver=1&docid=80.1&bc=gaaaaagaaaaaaa%3d%3d&. Accessed November 21, 2017. 80.4 Hydrophilic Contact Lenses. CMS website. http://www.cms.gov/medicare-coveragedatabase/details/ncd-details.aspx?ncdid=233&ver=1. Accessed November 21, 2017. Scleral Shell (80.5). CMS website. http://www.cms.gov/medicare-coverage-database/details/ncddetails.aspx?ncdid=235&ncdver=1&bc=aaaaqaaaaaaa&. Accessed November 21, 2017. Local Coverage Determinations (LCDs): L36237 Amniotic Membrane- Sutureless Placement on the Ocular Surface. CMS website. https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?lcdid=36237&ver=5. Accessed November 21, 2017. L36232 Diagnostic Evaluation and Medical Management of Moderate-Severe Dry Eye Disease (DED). CMS website. https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?lcdid=36232&ver=5. Accessed November 21, 2017. Commonly submitted codes Below are the most commonly submitted codes for the service(s)/item(s) subject to this policy. This is not an exhaustive list of codes. Providers are expected to consult the appropriate coding manuals and bill accordingly. CPT Code Description Comments 92071 Fitting of contact lens for treatment of ocular surface disease 92072 Fitting of contact lens for management of keratoconus; initial fitting Prescription of optical and physical characteristics of and fitting of contact lens, 92310 with medical supervision of adaptation, corneal lens, both eyes, except for aphakia 92311 Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, 1 eye 92312 Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, both eyes 92313 Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneoscleral lens 92314 Prescription of optical and physical characteristics of contact lens, with medical 8
CPT Code Description Comments 92315 92316 92317 supervision of adaptation and direction of fitting by independent technician; corneal lens, both eyes except for aphakia Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneal lens for aphakia, 1 eye Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneal lens for aphakia, both eyes Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneoscleral lens ICD-10 Code Description Comments B55.2 Mucocutaneous leishmaniasis H02.051 Trichiasis without entropian right upper eyelid H02.052 Trichiasis without entropian right lower eyelid H02.053 Trichiasis without entropian right eye, unspecified eyelid H02.054 Trichiasis without entropian left upper eyelid H02.055 Trichiasis without entropian left lower eyelid H02.056 Trichiasis without entropian left eye, unspecified eyelid H02.059 Trichiasis without entropian unspecified eye, unspecified eyelid H02.89 Other specified disorders of eyelid H02.9 Unspecified disorder of eyelid H04.121 Dry eye syndrome of right lacrimal gland H04.122 Dry eye syndrome of left lacrimal gland H04.123 Dry eye syndrome of bilateral lacrimal glands H04.129 Dry eye syndrome of unspecified lacrimal gland H04.141 Primary lacrimal gland atrophy, right lacrimal gland H04.142 Primary lacrimal gland atrophy, left lacrimal gland H04.143 Primary lacrimal gland atrophy, bilateral lacrimal glands H04.149 Primary lacrimal gland atrophy, unspecified lacrimal gland H04.151 Secondary lacrimal gland atrophy, right lacrimal gland H04.152 Secondary lacrimal gland atrophy, left lacrimal gland H04.153 Secondary lacrimal gland atrophy, bilateral lacrimal glands H04.159 Secondary lacrimal gland atrophy, unspecified lacrimal gland H04.69 Other changes of lacrimal passages H10.211 Acute toxic conjunctivitis, right eye H10.212 Acute toxic conjunctivitis, left eye H10.213 Acute toxic conjunctivitis, bilateral H10.219 Acute toxic conjunctivitis, unspecified eye H10.89 Other conjunctivitis H11.241 Scarring of conjunctiva, right eye H11.242 Scarring of conjunctiva, left eye H11.243 Scarring of conjunctiva, bilateral H11.249 Scarring of conjunctiva, unspecified eye H16.121 Filamentary keratitis, right eye 9
ICD-10 Code Description Comments H16.122 Filamentary keratitis, left eye H16.123 Filamentary keratitis, bilateral H16.129 Filamentary keratitis, unspecified eye H16.141 Punctate keratitis, right eye H16.142 Punctate keratitis, left eye H16.143 Punctate keratitis, bilateral H16.149 Punctate keratitis, unspecified eye H16.211 Exposure keratoconjunctivitis, right eye H16.212 Exposure keratoconjunctivitis, left eye H16.213 Exposure keratoconjunctivitis, bilateral H16.219 Exposure keratoconjunctivitis, unspecified eye H16.221 Keratoconjunctivitis sicca, not specified as Sjogren's, right eye H16.222 Keratoconjunctivitis sicca, not specified as Sjogren's, left eye H16.223 Keratoconjunctivitis sicca, not specified as Sjogren's, bilateral H16.229 Keratoconjunctivitis sicca, not specified as Sjogren's, unspecified eye H16.231 Neurotrophic keratoconjunctivitis, right eye H16.232 Neurotrophic keratoconjunctivitis, left eye H16.233 Neurotrophic keratoconjunctivitis, bilateral H16.239 Neurotrophic keratoconjunctivitis, unspecified eye H16.261 Vernal keratoconjunctivitis, with limbar and corneal involvement, right eye H16.262 Vernal keratoconjunctivitis, with limbar and corneal involvement, left eye H16.263 Vernal keratoconjunctivitis, with limbar and corneal involvement, bilateral H16.269 Vernal keratoconjunctivitis, with limbar and corneal involvement, unspecified eye H16.291 Other keratoconjunctivitis, right eye H16.292 Other keratoconjunctivitis, left eye H16.293 Other keratoconjunctivitis, bilateral H16.299 Other keratoconjunctivitis, unspecified eye H18.10 Bullous keratopathy, unspecified eye H18.11 Bullous keratopathy, right eye H18.12 Bullous keratopathy, left eye H18.13 Bullous keratopathy, bilateral H18.40 Unspecified corneal degeneration H18.411 Arcus senilis, right eye H18.412 Arcus senilis, left eye H18.413 Arcus senilis, bilateral H18.419 Arcus senilis, unspecified eye H18.421 Band keratopathy, right eye H18.422 Band keratopathy, left eye H18.423 Band keratopathy, bilateral H18.429 Band keratopathy, unspecified eye H18.43 Other calcerous corneal degeneration H18.441 Keratomalacia, right eye H18.442 Keratomalacia, left eye H18.443 Keratomalacia, bilateral H18.449 Keratomalacia, unspecified eye H18.451 Nodular corneal degeneration, right eye 10
ICD-10 Code Description Comments H18.452 Nodular corneal degeneration, left eye H18.453 Nodular corneal degeneration, bilateral H18.459 Nodular corneal degeneration, unspecified eye H18.461 Peripheral corneal degeneration, right eye H18.462 Peripheral corneal degeneration, left eye H18.463 Peripheral corneal degeneration, bilateral H18.469 Peripheral corneal degeneration, unspecified eye H18.49 Other corneal degeneration H18.51 Endothelial corneal dystrophy H18.53 Granular corneal dystrophy H18.54 Lattice corneal dystrophy H18.55 Macular corneal dystrophy H18.59 Other hereditary corneal dystrophies H18.601 Keratoconus, unspecified, right eye H18.602 Keratoconus, unspecified, left eye H18.603 Keratoconus, unspecified, bilateral H18.609 Keratoconus, unspecified, unspecified eye H18.611 Keratoconus, stable, right eye H18.612 Keratoconus, stable, left eye H18.613 Keratoconus, stable, bilateral H18.619 Keratoconus, stable, unspecified eye H18.621 Keratoconus, unstable, right eye H18.622 Keratoconus, unstable, left eye H18.623 Keratoconus, unstable, bilateral H18.629 Keratoconus, unstable, unspecified eye H18.711 Corneal ectasia, right eye H18.712 Corneal ectasia, left eye H18.713 Corneal ectasia, bilateral H18.719 Corneal ectasia, unspecified eye H18.731 Descemetocele, right eye H18.732 Descemetocele, left eye H18.733 Descemetocele, bilateral H18.739 Descemetocele, unspecified eye H18.831 Recurrent erosion of cornea, right eye H18.832 Recurrent erosion of cornea, left eye H18.833 Recurrent erosion of cornea, bilateral H18.839 Recurrent erosion of cornea, unspecified eye L12.1 Cicatricial pemphigoid L12.30 Acquired epidermolysis bullosa, unspecified L12.31 Epidermolysis bullosa due to drug L12.35 Other acquired epidermolysis bullosa L51.0 Nonbullous erythema multiforme L51.1 Stevens-Johnson syndrome L51.2 Toxic epidermal necrolysis [Lyell] L51.3 Stevens-Johnson syndrome-toxic epidermal necrolysis overlap syndrome L51.8 Other erythema multiforme L51.9 Erythema multiforme, unspecified 11
ICD-10 Code Description Comments M35.00 Sicca syndrome, unspecified M35.01 Sicca syndrome with keratoconjunctivitis M35.02 Sicca syndrome with lung involvement M35.03 Sicca syndrome with myopathy M35.04 Sicca syndrome with tubulo-interstitial nephropa M35.09 Sicca syndrome with other organ involvement Q10.0 Congenital ptosis Q10.1 Congenital ectropion Q10.2 Congenital entropion Q10.3 Other congenital malformations of eyelid Q10.4 Absence and agenesis of lacrimal apparatus Q10.5 Congenital stenosis and stricture of lacrimal duct Q10.6 Other congenital malformations of lacrimal apparatus S00.201A Unspecified superficial injury of right eyelid and periocular area, initial S00.202A Unspecified superficial injury of left eyelid and periocular area, initial S00.209A Unspecified superficial injury of unspecified eyelid and periocular area, initial S00.211A Abrasion of right eyelid and periocular area, initial S00.212A Abrasion of left eyelid and periocular area, initial S00.219A Abrasion of unspecified eyelid and periocular area, initial S00.221A Blister (nonthermal) of right eyelid and periocular area, initial S00.222A Blister (nonthermal) of left eyelid and periocular area, initial S00.229A Blister (nonthermal) of unspecified eyelid and periocular area, initial S00.241A External constriction of right eyelid and periocular area, initial S00.242A External constriction of left eyelid and periocular area, initial S00.249A External constriction of unspecified eyelid and periocular area, initial S00.251A Superficial foreign body of right eyelid and periocular area, initial S00.252A Superficial foreign body of left eyelid and periocular area, initial S00.259A Superficial foreign body of unspecified eyelid and periocular area, initial S00.261A Insect bite (nonvenomous) of right eyelid and periocular area, initial S00.262A Insect bite (nonvenomous) of left eyelid and periocular area, initial S00.269A Insect bite (nonvenomous) of unspecified eyelid and periocular area, initial S00.271A Other superficial bite of right eyelid and periocular area, initial S00.272A Other superficial bite of left eyelid and periocular area, initial S00.279A Other superficial bite of unspecified eyelid and periocular area, initial S05.00XA Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, initial S05.01XA Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial S05.02XA Injury of conjunctiva and corneal abrasion without foreign body, left eye, initial S05.20XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, unspecified eye, initial S05.21XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, right eye, initial 12
ICD-10 Code Description Comments S05.22XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, initial S05.30XA Ocular laceration without prolapse or loss of intraocular tissue, unspecified eye, initial S05.30XA Ocular laceration without prolapse or loss of intraocular tissue, unspecified eye, initial S05.31XA Ocular laceration without prolapse or loss of intraocular tissue, right eye, initial S05.32XA Ocular laceration without prolapse or loss of intraocular tissue, left eye, initial S05.50XA Penetrating wound with foreign body of unspecified eyeball, initial S05.51XA S05.52XA S05.60XA S05.61XA S05.62XA S05.70XA S05.71XA S05.72XA S05.8X1A S05.8X2A S05.8X9A S05.90XA S05.91XA S05.92XA T26.10XA T26.11XA T26.12XA T26.60XA T26.61XA T26.62XA Penetrating wound with foreign body of right eyeball, initial Penetrating wound with foreign body of left eyeball, initial Penetrating wound without foreign body of unspecified eyeball, initial Penetrating wound without foreign body of right eyeball, initial Penetrating wound without foreign body of left eyeball, initial encount Avulsion of unspecified eye, initial Avulsion of right eye, initial Avulsion of left eye, initial Other injuries of right eye and orbit, initial Other injuries of left eye and orbit, initial Other injuries of unspecified eye and orbit, initial Unspecified injury of unspecified eye and orbit, initial Unspecified injury of right eye and orbit, initial Unspecified injury of left eye and orbit, initial Burn of cornea and conjunctival sac, unspecified eye, initial Burn of cornea and conjunctival sac, right eye, initial Burn of cornea and conjunctival sac, left eye, initial Corrosion of cornea and conjunctival sac, unspecified eye, initial Corrosion of cornea and conjunctival sac, right eye, initial Corrosion of cornea and conjunctival sac, left eye, initial Z94.7 Corneal transplant status HCPCS Level II Code S0515 V2530 V2531 Description Scleral lens, liquid bandage device, per lens Contact lens, scleral, gas impermeable, per lens Contact lens, scleral, gas permeable, per lens Comments 13