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ICD-10-CM H11.159, Pinguecula, unspecified eye | No Prior Auth

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`H11.159`, Pinguecula, unspecified eye

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Interpretation and report accompanying external ocular photography (consistent with CPT 92285: 'External ocular photography with interpretation and report for documentation of medical progress').
Clinical documentation demonstrating that photographs are being used to track and serially compare changes in the condition and that the photographic results may impact patient management and clinical outcomes.
Documentation that selection criteria (medical necessity indications listed in the policy) are met for the performed photography.
Records of the images (prints, slides, videotape or digital medium) and their storage as part of the medical record are acceptable.

Key Coverage Criteria

Acute inflammation of orbit, unspecified
Adherent leucoma
Argentous deposits
Benign neoplasm of conjunctiva
Adhesions of iris, unspecified
Corneal edema due to wearing of contact

1 Active Policy

AETNA-CPB-0734, External Ocular Photography

Related Codes

C31.0(1 policies)C31.9(1 policies)C78.39(1 policies)D02.3(1 policies)D14.0(1 policies)D38.5(1 policies)D49.1(1 policies)92285(1 policies)

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Documentation should indicate that the service is not being performed solely to document existence of a condition for enhancement of the medical record (i.e., show an impact on management or decision-making).