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ICD-10-CM H40.30X3, Glaucoma secondary to eye trauma, unspecified eye, severe stage | No Prior Auth

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`H40.30X3`, Glaucoma secondary to eye trauma, unspecified eye, severe stage

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.

The submitted medical record must support the use of the selected ICD-10-CM code(s).

The submitted CPT/HCPCS code must accurately describe the service performed.

If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of test results and interpretation and retain copies of the ordering/referring physician’s order for the studies.

Key Coverage Criteria

Visual field examinations are covered when reasonable and necessary as defined by Local Coverage Determination (LCD) L33766.
Visual field examination is covered for patients with inflammation or disorders of the eyelids that may affect the visual field.
Visual field examination is covered for patients with a documented diagnosis of glaucoma.
Visual field examination is covered for glaucoma suspects, defined by increased intraocular pressure, inter-eye intraocular pressure asymmetry greater than 2–3 mm Hg, or optic nerve findings suspicious for glaucoma (asymmetric cupping, disc hemorrhage, absent or thinned temporal rim).
Visual field examination is covered for patients with a documented disorder of the optic nerve, neurologic visual pathway, or retina.
Visual field examination is covered for patients with a recent intracranial hemorrhage, intracranial mass, or recent measurement of increased intracranial pressure, with or without visual symptoms.

2 Active Policies

FIRST_COAST-L33766, Visual Field Examination

J9

A57637, Billing and Coding: Visual Field Examination

J9

Related Codes

92082(2 policies)92083(2 policies)A18.52(2 policies)A18.53(2 policies)A18.54(2 policies)A18.59(2 policies)A52.12(2 policies)92081(2 policies)

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