Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 07.13.11i


Attachment:

A

Policy #:07.13.11i

Description:ICD-10 Codes

Title:Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



ICD-10 Codes

D89.811 Chronic graft-versus-host disease

D89.812 Acute on chronic graft-versus-host disease

H02.051 Trichiasis without entropion right upper eyelid

H02.052 Trichiasis without entropion right lower eyelid

H02.053 Trichiasis without entropion right eye, unspecified eyelid

H02.054 Trichiasis without entropion left upper eyelid

H02.055 Trichiasis without entropion left lower eyelid

H02.056 Trichiasis without entropion left eye, unspecified eyelid

H02.059 Trichiasis without entropion unspecified eye, unspecified eyelid

H02.881 Meibomian gland dysfunction right upper eyelid

H02.882 Meibomian gland dysfunction right lower eyelid

H02.883 Meibomian gland dysfunction of right eye, unspecified eyelid

H02.884 Meibomian gland dysfunction left upper eyelid

H02.885 Meibomian gland dysfunction left lower eyelid

H02.886 Meibomian gland dysfunction of left eye, unspecified eyelid

H02.889 Meibomian gland dysfunction of unspecified eye, unspecified eyelid

H02.88A Meibomian gland dysfunction right eye, upper and lower eyelids

H02.88B Meibomian gland dysfunction left eye, upper and lower eyelids

H10.821 Rosacea conjunctivitis, right eye

H10.822 Rosacea conjunctivitis, left eye

H10.823 Rosacea conjunctivitis, bilateral

H10.829 Rosacea conjunctivitis, unspecified eye

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

H04.19 Other specified disorders of lacrimal gland

H04.69 Other changes of lacrimal passages

H04.89 Other disorders of lacrimal system

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

H16.101 Unspecified superficial keratitis, right eye

H16.102 Unspecified superficial keratitis, left eye

H16.103 Unspecified superficial keratitis, bilateral

H16.121 Filamentary keratitis, right eye

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

H16.231 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

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

H18.49 Other corneal degeneration

H18.53 Granular corneal dystrophy

H18.54 Lattice corneal dystrophy

H18.55 Macular corneal dystrophy

H18.601 Keratoconus, unspecified, right eye

H18.602 Keratoconus, unspecified, left eye

H18.603 Keratoconus, unspecified, bilateral

H18.469 Peripheral corneal degeneration, 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

H18.70 Unspecified corneal deformity

H18.711 Corneal ectasia, right eye

H18.712 Corneal ectasia, left eye

H18.713 Corneal ectasia, bilateral

H18.719 Corneal ectasia, unspecified eye

H18.791 Other corneal deformities, right eye

H18.792 Other corneal deformities, left eye

H18.793 Other corneal deformities, bilateral

H18.799 Other corneal deformities, 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

H18.9 Unspecified disorder of cornea

H21.241 Degeneration of pupillary margin, right eye

H21.242 Degeneration of pupillary margin, left eye

H21.243 Degeneration of pupillary margin, bilateral

H21.249 Degeneration of pupillary margin, unspecified eye

H52.211 Irregular astigmatism, right eye

H52.212 Irregular astigmatism, left eye

H52.213 Irregular astigmatism, bilateral

H52.219 Irregular astigmatism, 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

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 nephropathy

M35.09 Sicca syndrome with other organ involvement

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

Q13.4 Other congenital corneal malformations

Q15.0 Congenital glaucoma

Q15.9 Congenital malformation of eye, unspecified

S00.201A Unspecified superficial injury of right eyelid and periocular area, initial encounter

S00.201D Unspecified superficial injury of right eyelid and periocular area, subsequent encounter

S00.201S Unspecified superficial injury of right eyelid and periocular area, sequela

S00.202A Unspecified superficial injury of left eyelid and periocular area, initial encounter

S00.202D Unspecified superficial injury of left eyelid and periocular area, subsequent encounter

S00.202S Unspecified superficial injury of left eyelid and periocular area, sequela

S00.211A Abrasion of right eyelid and periocular area, initial encounter

S00.211D Abrasion of right eyelid and periocular area, subsequent encounter

S00.211S Abrasion of right eyelid and periocular area, sequela

S00.212A Abrasion of left eyelid and periocular area, initial encounter

S00.212D Abrasion of left eyelid and periocular area, subsequent encounter

S00.212S Abrasion of left eyelid and periocular area, sequela

S00.219A Abrasion of unspecified eyelid and periocular area, initial encounter

S00.221A Blister (nonthermal) of right eyelid and periocular area, initial encounter

S00.221D Blister (nonthermal) of right eyelid and periocular area, subsequent encounter

S00.221S Blister (nonthermal) of right eyelid and periocular area, sequela

S00.222A Blister (nonthermal) of left eyelid and periocular area, initial encounter

S00.222D Blister (nonthermal) of left eyelid and periocular area, subsequent encounter

S00.222S Blister (nonthermal) of left eyelid and periocular area, sequela

S00.241A External constriction of right eyelid and periocular area, initial encounter

S00.241D External constriction of right eyelid and periocular area, subsequent encounter

S00.241S External constriction of right eyelid and periocular area, sequela

S00.242A External constriction of left eyelid and periocular area, initial encounter

S00.242D External constriction of left eyelid and periocular area, subsequent encounter

S00.242S External constriction of left eyelid and periocular area, sequela

S00.251A Superficial foreign body of right eyelid and periocular area, initial encounter

S00.251D Superficial foreign body of right eyelid and periocular area, subsequent encounter

S00.251S Superficial foreign body of right eyelid and periocular area, sequela

S00.252A Superficial foreign body of left eyelid and periocular area, initial encounter

S00.252D Superficial foreign body of left eyelid and periocular area, subsequent encounter

S00.252S Superficial foreign body of left eyelid and periocular area, sequela

S00.261A Insect bite (nonvenomous) of right eyelid and periocular area, initial encounter

S00.261D Insect bite (nonvenomous) of right eyelid and periocular area, subsequent encounter

S00.261S Insect bite (nonvenomous) of right eyelid and periocular area, sequela

S00.262A Insect bite (nonvenomous) of left eyelid and periocular area, initial encounter

S00.262D Insect bite (nonvenomous) of left eyelid and periocular area, subsequent encounter

S00.262S Insect bite (nonvenomous) of left eyelid and periocular area, sequela

S00.271A Other superficial bite of right eyelid and periocular area, initial encounter

S00.271D Other superficial bite of right eyelid and periocular area, subsequent encounter

S00.271S Other superficial bite of right eyelid and periocular area, sequela

S00.272A Other superficial bite of left eyelid and periocular area, initial encounter

S00.272D Other superficial bite of left eyelid and periocular area, subsequent encounter

S00.272S Other superficial bite of left eyelid and periocular area, sequela

S05.01xA Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter

S05.01xD Injury of conjunctiva and corneal abrasion without foreign body, right eye, subsequent encounter

S05.01xS Injury of conjunctiva and corneal abrasion without foreign body, right eye, sequela

S05.02xA Injury of conjunctiva and corneal abrasion without foreign body, left eye, initial encounter

S05.02xD Injury of conjunctiva and corneal abrasion without foreign body, left eye, subsequent encounter

S05.02xS Injury of conjunctiva and corneal abrasion without foreign body, left eye, sequela

S05.21xA Ocular laceration and rupture with prolapse or loss of intraocular tissue, right eye, initial encounter

S05.21xD Ocular laceration and rupture with prolapse or loss of intraocular tissue, right eye, subsequent encounter

S05.21xS Ocular laceration and rupture with prolapse or loss of intraocular tissue, right eye, sequela

S05.22xA Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, initial encounter

S05.22xD Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, subsequent encounter

S05.22xS Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, sequela

S05.31xA Ocular laceration without prolapse or loss of intraocular tissue, right eye, initial encounter

S05.31xD Ocular laceration without prolapse or loss of intraocular tissue, right eye, subsequent encounter

S05.31xS Ocular laceration without prolapse or loss of intraocular tissue, right eye, sequela

S05.32xA Ocular laceration without prolapse or loss of intraocular tissue, left eye, initial encounter

S05.32xD Ocular laceration without prolapse or loss of intraocular tissue, left eye, subsequent encounter

S05.32xS Ocular laceration without prolapse or loss of intraocular tissue, left eye, sequela

S05.51xA Penetrating wound with foreign body of right eyeball, initial encounter

S05.51xD Penetrating wound with foreign body of right eyeball, subsequent encounter

S05.51xS Penetrating wound with foreign body of right eyeball, sequela

S05.52xA Penetrating wound with foreign body of left eyeball, initial encounter

S05.52xD Penetrating wound with foreign body of left eyeball, subsequent encounter

S05.52xS Penetrating wound with foreign body of left eyeball, sequela

S05.61xA Penetrating wound without foreign body of right eyeball, initial encounter

S05.61xD Penetrating wound without foreign body of right eyeball, subsequent encounter

S05.61xS Penetrating wound without foreign body of right eyeball, sequela

S05.62xA Penetrating wound without foreign body of left eyeball, initial encounter

S05.62xD Penetrating wound without foreign body of left eyeball, subsequent encounter

S05.62xS Penetrating wound without foreign body of left eyeball, sequela

S05.71xA Avulsion of right eye, initial encounter

S05.71xD Avulsion of right eye, subsequent encounter

S05.71xS Avulsion of right eye, sequela

S05.72xA Avulsion of left eye, initial encounter

S05.72xD Avulsion of left eye, subsequent encounter

S05.72xS Avulsion of left eye, sequela

S05.8x1A Other injuries of right eye and orbit, initial encounter

S05.8x1D Other injuries of right eye and orbit, subsequent encounter

S05.8x1S Other injuries of right eye and orbit, sequela

S05.8x2A Other injuries of left eye and orbit, initial encounter

S05.8x2D Other injuries of left eye and orbit, subsequent encounter

S05.8x2S Other injuries of left eye and orbit, sequela

S05.91xA Unspecified injury of right eye and orbit, initial encounter

S05.91xD Unspecified injury of right eye and orbit, subsequent encounter

S05.91xS Unspecified injury of right eye and orbit, sequela

S05.92xA Unspecified injury of left eye and orbit, initial encounter

S05.92xD Unspecified injury of left eye and orbit, subsequent encounter

S05.92xS Unspecified injury of left eye and orbit, sequela

T26.11xA Burn of cornea and conjunctival sac, right eye, initial encounter

T26.11xD Burn of cornea and conjunctival sac, right eye, subsequent encounter

T26.11xS Burn of cornea and conjunctival sac, right eye, sequela

T26.12xA Burn of cornea and conjunctival sac, left eye, initial encounter

T26.12xD Burn of cornea and conjunctival sac, left eye, subsequent encounter

T26.12xS Burn of cornea and conjunctival sac, left eye, sequela

T26.61xA Corrosion of cornea and conjunctival sac, right eye, initial encounter

T26.61xD Corrosion of cornea and conjunctival sac, right eye, subsequent encounter

T26.61xS Corrosion of cornea and conjunctival sac, right eye, sequela

T26.62xA Corrosion of cornea and conjunctival sac, left eye, initial encounter

T26.62xD Corrosion of cornea and conjunctival sac, left eye, subsequent encounter

T26.62xS Corrosion of cornea and conjunctival sac, left eye, sequela

T66.xxxA Radiation sickness, unspecified, initial encounter

T66.xxxD Radiation sickness, unspecified, subsequent encounter

T66.xxxS Radiation sickness, unspecified, sequela

Z85.840 Personal history of malignant neoplasm of eye

Z94.7 Corneal transplant status

Z98.890 Other Specified postprocedural states

Version Effective Date: 10/01/2018
Version Issued Date: 10/01/2018
Version Reissued Date: N/A

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