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ICD-10-CM Z12.89, Encounter for screening for malignant neoplasm of other sites | No Prior Auth

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`Z12.89`, Encounter for screening for malignant neoplasm of other sites

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Extended ophthalmoscopy includes a detailed retinal drawing (disc, macula or periphery) accompanied by an interpretation and plan
The drawing should be anatomically specific to the patient and clearly labeled
The drawing should be of sufficient size, usually no less than 2.5 inches in diameter
Documentation should support medical necessity (i.e., that the extended ophthalmoscopy will provide additive, non-duplicative information that will affect management)

Key Coverage Criteria

Blunt injury to the eye or periorbital structures
Chorioretinitis, chorioretinal scars or choroidal degeneration, dystrophies, hemorrhage and rupture, or detachment
Degenerative disorders of the globe
Diabetic retinopathy (i.e., background retinopathy or proliferative retinopathy retinal vascular occlusion, or separation of the retinal layers)
Disorders of the vitreous body (i.e., vitreous hemorrhage or posterior vitreous detachment)
High axial length myopia (-6.00 Diopters or less [toward -10.00 D])

4 Active Policies

AETNA-CPB-0352, Tumor Markers

AETNA-CPB-0738, Upper Gastrointestinal Endoscopy and Gastrointestinal Biopsy

AETNA-CPB-0767, Extended Ophthalmoscopy

AETNA-CPB-0783, In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions

Related Codes

C44.42(2 policies)C61(2 policies)C34.00(2 policies)C34.92(2 policies)C56.1(2 policies)C56.9(2 policies)C15.3(2 policies)C67.0(2 policies)

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CPT codes covered if selection criteria are met: 92201; 92202

The extensive scaled drawing should accurately represent normal, abnormal and common findings such as lattice degeneration, hypertensive vascular changes, proliferative diabetic retinopathy, retinal detachments, holes, tears, or tumors