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ICD-10-CM H05.429, Enophthalmos due to trauma or surgery, unspecified eye | No Prior Auth

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`H05.429`, Enophthalmos due to trauma or surgery, unspecified eye

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.
Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.
Refer to NCCI and OPPS requirements prior to billing Medicare to ensure coding compliance and to determine any bundling or packaging edits.

Key Coverage Criteria

Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Acute inflammation of orbit, unspecified
Adherent leucoma
Argentous deposits
Benign neoplasm of conjunctiva
Adhesions of iris, unspecified

6 Active Policies

NGS-J6-L33574, Visual Fields Testing

J6

A56551, Billing and Coding: Visual Fields Testing

J6

FIRST_COAST-L33766, Visual Field Examination

J9

A57637, Billing and Coding: Visual Field Examination

J9

NGS-JK-L33574, Visual Fields Testing

Related Codes

H05.421(6 policies)A52.15(5 policies)92082(5 policies)92081(5 policies)A18.53(5 policies)92083(5 policies)A52.12(5 policies)A52.14(5 policies)

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All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

Every page of the record must be legible and include appropriate patient identification information such as complete name and dates of service.

JK

AETNA-CPB-0734, External Ocular Photography