Notification

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)


Notification Issue Date: 06/13/2018

This version of the policy will become effective 09/10/2018.

As part of the update, medical necessity criteria are being amended as follows:

  • The conditions covered for anterior segment evaluation include specified forms of glaucoma and certain disorders of the cornea, iris and ciliary body.
  • The conditions covered for posterior segment evaluation include conditions affecting the optic nerve (e.g., optic neuropathy) or retinal disease (e.g., macular degeneration, diabetic retinopathy) and certain macular abnormalities (e.g., macular edema, atrophy associated with degenerative retinal diseases).
  • The covered retinal conditions in active treatment for which one exam, per eye, per month may be appropriate include wet age-related macular degeneration (AMD), choroidal neovascularization, macular edema, diabetic retinopathy (proliferative and nonproliferative), branch retinal vein occlusion, central retinal vein occlusion, and cystoid macular edema.
  • The timing of monitoring individuals being treated with chloroquine (CQ) and/or hydroxychloroquine (HCQ) to align with FDA labeling.
    • Baseline examination within the first year of treatment and as an annual follow-up after five years of treatment. For higher-risk individuals, annual testing may begin immediately (without a 5-year delay).

In addition, the covered diagnosis codes for SCODI have been updated in the coding table to represent covered conditions.


Medical Policy Bulletin


Title:Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

Policy #:07.13.06k

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract.

MEDICALLY NECESSARY

Scanning computerized ophthalmic diagnostic imaging (SCODI) of the anterior segment is considered medically necessary and, therefore, covered for the evaluation of specified forms of glaucoma and certain disorders of the cornea, iris and ciliary body, for up to two exams per eye, per year.

SCODI of the posterior segment is considered medically necessary and, therefore, covered for the following indications, at the specified frequencies:
  • For the diagnosis and management of an individual who has mild, moderate, severe, or indeterminate stage glaucoma or who is suspected of having glaucoma.
    • Up to two exams, per eye, per year for management of individuals who have or are suspected of having glaucoma
  • For the monitoring of individuals being treated with chloroquine (CQ) and/or hydroxychloroquine (HCQ) for the development of retinopathy.
    • Individuals should receive a baseline examination within the first year of treatment and as an annual follow-up after five years of treatment. For higher-risk individuals, annual testing may begin immediately (without a 5-year delay).
  • For the evaluation and treatment of individuals with conditions affecting the optic nerve (e.g., optic neuropathy) or retinal disease (e.g., macular degeneration, diabetic retinopathy) and in the evaluation and treatment of certain macular abnormalities (e.g., macular edema, atrophy associated with degenerative retinal diseases).
    • Up to one exam per eye, every 2 months to manage an individual whose primary ophthalmological condition is related to a retinal disease that is not undergoing active treatment; however, if an individual with retinal conditions is in active treatment, one exam, per eye, per month may be appropriate. These conditions include wet age-related macular degeneration (AMD), choroidal neovascularization, macular edema, diabetic retinopathy (proliferative and nonproliferative), branch retinal vein occlusion, central retinal vein occlusion, and cystoid macular edema.
    • Up to one exam per eye, every month may be appropriate to manage other conditions which may undergo rapid clinical changes requiring aggressive therapy and frequent follow-up (e.g. macular hole and traction retinal detachment)

EXPERIMENTAL/INVESTIGATIONAL

All other indications for SCODI are considered experimental/investigational and, therefore, not covered because their safety and/or effectiveness cannot be established by review of the available published literature.

NOT MEDICALLY NECESSARY

Exams exceeding the frequency limits per indication in the Medically Necessary section are considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support their clinical use in any indications. The Company will not reimburse for more than twenty (20) SCODI procedures/year.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

If bilateral studies are reported, the documentation maintained by the provider must demonstrate medical necessity for the test to be performed in each eye.
Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, SCODI is covered under the medical benefits of the Company’s products when the medical necessity criteria in the medical policy are met.

However, services that are identified in this policy as not medically necessary are not eligible for coverage or reimbursement by the Company.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

There are numerous SCODI devices approved by the US Food and Drug Administration (FDA).

Description

GLAUCOMA

Glaucoma is a leading cause of blindness, and a disease for which treatment methods clearly are available and in common use. Scanning computerized ophthalmic diagnostic imaging (SCODI) allows for early detection of glaucomatous damage to the nerve fiber layer or optic nerve of the eye. It is the goal of these diagnostic imaging tests to discriminate among individuals with normal intraocular pressure (IOP) who have glaucoma, individuals with elevated IOP who have glaucoma, and individuals with elevated IOP who do not have glaucoma. These tests can also provide precise methods of observation of the optic nerve head and can more accurately reveal subtle glaucomatous changes over the course of follow-up exams than visual field and/or disc photos. This can allow earlier and more efficient treatment of the disease process. The severity of glaucoma damage can be estimated as mild, moderate, severe or indeterminate.

RETINAL DISORDERS

Retinal disorders are the most common causes of severe and permanent vision loss. SCODI is a valuable tool for the evaluation and treatment of individuals with retinal disease, especially macular abnormalities. SCODI can detail the microscopic anatomy of the retina and the vitreo-retinal interface. SCODI is useful to measure the effectiveness of therapy, in determining the need for ongoing therapy, or cessation of therapy.

The retina is a complex tissue in the back of the eye that contains specialized photoreceptor cells called rods and cones. The photoreceptors connect to a network of nerve cells for the local processing of visual information. This information is sent to the brain for decoding into a visual image. The adjacent retinal pigment epithelium (RPE) supports many of the retina’s metabolic functions.

The retina is susceptible to a variety of diseases, including age-related macular degeneration (AMD), diabetic retinopathy (DR), retinitis pigmentosa (RP) and other inherited retinal degenerations, uveitis, retinal detachment, and eye cancers. Each of these can lead to visual loss or complete blindness.

The leading cause of visual loss among elderly persons is AMD, which has an increasingly important social and economic impact in the United States. As the size of the elderly population increases in this country, AMD will become a more prevalent cause of blindness than both DR and glaucoma combined.

DR is also a major cause of blindness. In the proliferative stage of the disease, newly formed, abnormal blood vessels can break through the retinal surface and hemorrhage into the normally transparent, gelatin-like vitreous in the middle of the eye. Scar tissue may subsequently form and pull the retina away from the back of the eye, causing a retinal detachment to occur.

Rare inherited retinal degenerations, typified by RP, result in the destruction of photoreceptor cells and the RPE.

Clinical evidence has shown that long-term use of chloroquine (CQ) and/or hydroxychloroquine (HCQ) can lead to irreversible retinal toxicity. SCODI may be indicated to provide monitoring of individuals for the development of retinopathy during long-term therapy.

SCODI TECHNIQUES

There are several forms of SCODI tests that currently exist. SCODI testing includes scanning laser polarimetry (SLP), optical coherence tomography (OCT), and confocal scanning laser ophthalmoscopy (CSLO). These testing devices use videographic digitized images to make quantitative topographic measurements of the optic nerve head and surrounding retina. Although these techniques are different, their objective is the same. These methods are described below:
  • Scanning Laser Polarimetry (SLP)
    The retinal nerve fiber layer (RNFL) is birefringent, causing a change in the state of polarization of a laser beam as it passes. A 780-nm diode laser is used to illuminate the optic nerve. The polarization state of the light emerging from the eye is then evaluated and correlated with RNFL thickness. Unlike CSLO, SLP can directly measure the thickness of the RNFL. GDx is a common example of a scanning laser polarimeter. GDx contains a normative database and statistical software package to allow comparison to age-matched normal subjects of the same ethnic origin. The advantages of this system are that images can be obtained without pupil dilation, and evaluation can be done in about 10 minutes. Current instruments have added enhanced and variable corneal compensation technology to account for corneal polarization.
  • Optical Coherence Tomography (OCT)
    OCT uses near-infrared light to provide direct cross-sectional measurement of the retinal nerve fiber layer. The principals employed are similar to those used in B-mode ultrasound except light, not sound, is used to produce the 3-dimensional images. The light source can be directed into the eye through a conventional slit-lamp biomicroscope and focused onto the retina through a typical 78-diopter lens. This system requires dilation of the individual’s pupil.
  • Confocal Scanning Laser Ophthalmoscopy (CSLO)
    CSLO is a laser-based image acquisition technique, which is intended to improve the quality of the examination compared to standard ophthalmologic examination. A laser is scanned across the retina along with a detector system. Only a single spot on the retina is illuminated at any time, resulting in a high-contrast image of great reproducibility that can be used to estimate the thickness of the RNFL. In addition, this technique does not require maximal mydriasis, which may be a problem in individuals with glaucoma. The Heidelberg Retinal Tomograph is probably the most common example of this technology.

References


Kalev-Landoy M, Day AC, Cordeiro MF, Migdal C. Optical coherence tomography in anterior segment imaging. Acta Ophthalmol Scand. 2007;85(4):427-430.

Nolan WP, See JL, Chew PT, et al. Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes. Ophthalmology. 2007;114(1):33-39.

Novitas Solutions, Inc. Local Coverage Determination (LCD). L35038: Scanning Computerized Opthalmic Diagnostic Imaging. [Novitas Solutions, Inc. Web site]. Original: 10/01/2015. (Revised: 01/25/2018). Available at: https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35038&ver=56&name=331*1&UpdatePeriod=728&bc=AQAAEAABAAAA&. Accessed January 31, 2018.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Optical Coherence Tomography (OCT). 510(k) summary. [FDA Web site]. 09/28/07. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf7/K071250.pdf. Accessed January 31, 2018.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Pentacam Scheimpflug Camera. 510(k) summary. [FDA Web site]. 09/16/03. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf3/K030719.pdf. Accessed January 31, 2018.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. SOCT Copernicus Spectral Optical Coherence Tomography. 510(k) summary. [FDA Web site]. 02/27/08. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf7/K071839.pdf. Accessed January 31, 2018.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Visante OCT. 510(k) summary. [FDA Web site]. 05/29/07. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf5/K051789.pdf. Accessed January 31, 2018.

Wolffsohn JS, Peterson RC. Anterior ophthalmic imaging. Clin Exp Optom. 2006;89(4):205-214.





Coding

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.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

92132, 92133, 92134


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

THE FOLLOWING CODES ARE CONSIDERED MEDICALLY NECESSARY WHEN REPORTED WITH 92132


C69.00 Malignant neoplasm of unspecified conjunctiva

C69.01 Malignant neoplasm of right conjunctiva

C69.02 Malignant neoplasm of left conjunctiva

C69.10 Malignant neoplasm of unspecified cornea

C69.11 Malignant neoplasm of right cornea

C69.12 Malignant neoplasm of left cornea

C69.40 Malignant neoplasm of unspecified ciliary body

C69.41 Malignant neoplasm of right ciliary body

C69.42 Malignant neoplasm of left ciliary body

H17.00 Adherent leukoma, unspecified eye

H17.01 Adherent leukoma, right eye

H17.02 Adherent leukoma, left eye

H17.03 Adherent leukoma, bilateral

H17.10 Central corneal opacity, unspecified eye

H17.11 Central corneal opacity, right eye

H17.12 Central corneal opacity, left eye

H17.13 Central corneal opacity, bilateral

H17.811 Minor opacity of cornea, right eye

H17.812 Minor opacity of cornea, left eye

H17.813 Minor opacity of cornea, bilateral

H17.819 Minor opacity of cornea, unspecified eye

H17.821 Peripheral opacity of cornea, right eye

H17.822 Peripheral opacity of cornea, left eye

H17.823 Peripheral opacity of cornea, bilateral

H17.829 Peripheral opacity of cornea, unspecified eye

H17.89 Other corneal scars and opacities

H18.211 Corneal edema secondary to contact lens, right eye

H18.212 Corneal edema secondary to contact lens, left eye

H18.213 Corneal edema secondary to contact lens, bilateral

H18.219 Corneal edema secondary to contact lens, unspecified eye

H18.221 Idiopathic corneal edema, right eye

H18.222 Idiopathic corneal edema, left eye

H18.223 Idiopathic corneal edema, bilateral

H18.229 Idiopathic corneal edema, unspecified eye

H18.231 Secondary corneal edema, right eye

H18.232 Secondary corneal edema, left eye

H18.233 Secondary corneal edema, bilateral

H18.239 Secondary corneal edema, unspecified eye

H21.221 Degeneration of ciliary body, right eye

H21.222 Degeneration of ciliary body, left eye

H21.223 Degeneration of ciliary body, bilateral

H21.229 Degeneration of ciliary body, unspecified eye

H21.231 Degeneration of iris (pigmentary), right eye

H21.232 Degeneration of iris (pigmentary), left eye

H21.233 Degeneration of iris (pigmentary), bilateral

H21.239 Degeneration of iris (pigmentary), unspecified eye

H21.271 Miotic pupillary cyst, right eye

H21.272 Miotic pupillary cyst, left eye

H21.273 Miotic pupillary cyst, bilateral

H21.279 Miotic pupillary cyst, unspecified eye

H21.301 Idiopathic cysts of iris, ciliary body or anterior chamber, right eye

H21.302 Idiopathic cysts of iris, ciliary body or anterior chamber, left eye

H21.303 Idiopathic cysts of iris, ciliary body or anterior chamber, bilateral

H21.309 Idiopathic cysts of iris, ciliary body or anterior chamber, unspecified eye

H21.311 Exudative cysts of iris or anterior chamber, right eye

H21.312 Exudative cysts of iris or anterior chamber, left eye

H21.313 Exudative cysts of iris or anterior chamber, bilateral

H21.319 Exudative cysts of iris or anterior chamber, unspecified eye

H21.321 Implantation cysts of iris, ciliary body or anterior chamber, right eye

H21.322 Implantation cysts of iris, ciliary body or anterior chamber, left eye

H21.323 Implantation cysts of iris, ciliary body or anterior chamber, bilateral

H21.329 Implantation cysts of iris, ciliary body or anterior chamber, unspecified eye

H21.89 Other specified disorders of iris and ciliary body

H40.021 Open angle with borderline findings, high risk, right eye

H40.022 Open angle with borderline findings, high risk, left eye

H40.023 Open angle with borderline findings, high risk, bilateral

H40.029 Open angle with borderline findings, high risk, unspecified eye

H40.031 Anatomical narrow angle, right eye

H40.032 Anatomical narrow angle, left eye

H40.033 Anatomical narrow angle, bilateral

H40.039 Anatomical narrow angle, unspecified eye

H40.061 Primary angle closure without glaucoma damage, right eye

H40.062 Primary angle closure without glaucoma damage, left eye

H40.063 Primary angle closure without glaucoma damage, bilateral

H40.069 Primary angle closure without glaucoma damage, unspecified eye

H40.211 Acute angle-closure glaucoma, right eye

H40.212 Acute angle-closure glaucoma, left eye

H40.213 Acute angle-closure glaucoma, bilateral

H40.219 Acute angle-closure glaucoma, unspecified eye

H40.2211 Chronic angle-closure glaucoma, right eye, mild stage

H40.2212 Chronic angle-closure glaucoma, right eye, moderate stage

H40.2213 Chronic angle-closure glaucoma, right eye, severe stage

H40.2214 Chronic angle-closure glaucoma, right eye, indeterminate stage

H40.2220 Chronic angle-closure glaucoma, left eye, stage unspecified

H40.2221 Chronic angle-closure glaucoma, left eye, mild stage

H40.2222 Chronic angle-closure glaucoma, left eye, moderate stage

H40.2223 Chronic angle-closure glaucoma, left eye, severe stage

H40.2224 Chronic angle-closure glaucoma, left eye, indeterminate stage

H40.2230 Chronic angle-closure glaucoma, bilateral, stage unspecified

H40.2231 Chronic angle-closure glaucoma, bilateral, mild stage

H40.2232 Chronic angle-closure glaucoma, bilateral, moderate stage

H40.2233 Chronic angle-closure glaucoma, bilateral, severe stage

H40.2234 Chronic angle-closure glaucoma, bilateral, indeterminate stage

H40.231 Intermittent angle-closure glaucoma, right eye

H40.232 Intermittent angle-closure glaucoma, left eye

H40.233 Intermittent angle-closure glaucoma, bilateral

H40.239 Intermittent angle-closure glaucoma, unspecified eye

H40.241 Residual stage of angle-closure glaucoma, right eye

H40.242 Residual stage of angle-closure glaucoma, left eye

H40.243 Residual stage of angle-closure glaucoma, bilateral

H40.249 Residual stage of angle-closure glaucoma, unspecified eye

H40.31X1 Glaucoma secondary to eye trauma, right eye, mild stage

H40.31X2 Glaucoma secondary to eye trauma, right eye, moderate stage

H40.31X3 Glaucoma secondary to eye trauma, right eye, severe stage

H40.31X4 Glaucoma secondary to eye trauma, right eye, indeterminate stage

H40.32X1 Glaucoma secondary to eye trauma, left eye, mild stage

H40.32X2 Glaucoma secondary to eye trauma, left eye, moderate stage

H40.32X3 Glaucoma secondary to eye trauma, left eye, severe stage

H40.32X4 Glaucoma secondary to eye trauma, left eye, indeterminate stage

H40.33X1 Glaucoma secondary to eye trauma, bilateral, mild stage

H40.33X2 Glaucoma secondary to eye trauma, bilateral, moderate stage

H40.33X3 Glaucoma secondary to eye trauma, bilateral, severe stage

H40.33X4 Glaucoma secondary to eye trauma, bilateral, indeterminate stage

T86.840 Corneal transplant rejection

T86.841 Corneal transplant failure

T86.842 Corneal transplant infection


THE FOLLOWING CODES ARE CONSIDERED MEDICALLY NECESSARY WHEN REPORTED WITH 92133

H40.011 Open angle with borderline findings, low risk, right eye

H40.012 Open angle with borderline findings, low risk, left eye

H40.013 Open angle with borderline findings, low risk, bilateral

H40.019 Open angle with borderline findings, low risk, unspecified eye

H40.021 Open angle with borderline findings, high risk, right eye

H40.022 Open angle with borderline findings, high risk, left eye

H40.023 Open angle with borderline findings, high risk, bilateral

H40.029 Open angle with borderline findings, high risk, unspecified eye

H40.031 Anatomical narrow angle, right eye

H40.032 Anatomical narrow angle, left eye

H40.033 Anatomical narrow angle, bilateral

H40.039 Anatomical narrow angle, unspecified eye

H40.041 Steroid responder, right eye

H40.042 Steroid responder, left eye

H40.043 Steroid responder, bilateral

H40.049 Steroid responder, unspecified eye

H40.051 Ocular hypertension, right eye

H40.052 Ocular hypertension, left eye

H40.053 Ocular hypertension, bilateral

H40.059 Ocular hypertension, unspecified eye

H40.061 Primary angle closure without glaucoma damage, right eye

H40.062 Primary angle closure without glaucoma damage, left eye

H40.063 Primary angle closure without glaucoma damage, bilateral

H40.069 Primary angle closure without glaucoma damage, unspecified eye

H40.1111 Primary open-angle glaucoma, right eye, mild stage

H40.1112 Primary open-angle glaucoma, right eye, moderate stage

H40.1113 Primary open-angle glaucoma, right eye, severe stage

H40.1114 Primary open-angle glaucoma, right eye, indeterminate stage

H40.1121 Primary open-angle glaucoma, left eye, mild stage

H40.1122 Primary open-angle glaucoma, left eye, moderate stage

H40.1123 Primary open-angle glaucoma, left eye, severe stage

H40.1124 Primary open-angle glaucoma, left eye, indeterminate stage

H40.1131 Primary open-angle glaucoma, bilateral, mild stage

H40.1132 Primary open-angle glaucoma, bilateral, moderate stage

H40.1133 Primary open-angle glaucoma, bilateral, severe stage

H40.1134 Primary open-angle glaucoma, bilateral, indeterminate stage

H40.1210 Low-tension glaucoma, right eye, stage unspecified

H40.1211 Low-tension glaucoma, right eye, mild stage

H40.1212 Low-tension glaucoma, right eye, moderate stage

H40.1213 Low-tension glaucoma, right eye, severe stage

H40.1214 Low-tension glaucoma, right eye, indeterminate stage

H40.1221 Low-tension glaucoma, left eye, mild stage

H40.1222 Low-tension glaucoma, left eye, moderate stage

H40.1223 Low-tension glaucoma, left eye, severe stage

H40.1224 Low-tension glaucoma, left eye, indeterminate stage

H40.1231 Low-tension glaucoma, bilateral, mild stage

H40.1232 Low-tension glaucoma, bilateral, moderate stage

H40.1233 Low-tension glaucoma, bilateral, severe stage

H40.1234 Low-tension glaucoma, bilateral, indeterminate stage

H40.1310 Pigmentary glaucoma, right eye, stage unspecified

H40.1311 Pigmentary glaucoma, right eye, mild stage

H40.1312 Pigmentary glaucoma, right eye, moderate stage

H40.1313 Pigmentary glaucoma, right eye, severe stage

H40.1314 Pigmentary glaucoma, right eye, indeterminate stage

H40.1321 Pigmentary glaucoma, left eye, mild stage

H40.1322 Pigmentary glaucoma, left eye, moderate stage

H40.1323 Pigmentary glaucoma, left eye, severe stage

H40.1324 Pigmentary glaucoma, left eye, indeterminate stage

H40.1331 Pigmentary glaucoma, bilateral, mild stage

H40.1332 Pigmentary glaucoma, bilateral, moderate stage

H40.1333 Pigmentary glaucoma, bilateral, severe stage

H40.1334 Pigmentary glaucoma, bilateral, indeterminate stage

H40.1411 Capsular glaucoma with pseudoexfoliation of lens, right eye, mild stage

H40.1412 Capsular glaucoma with pseudoexfoliation of lens, right eye, moderate stage

H40.1413 Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage

H40.1414 Capsular glaucoma with pseudoexfoliation of lens, right eye, indeterminate stage

H40.1421 Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stage

H40.1422 Capsular glaucoma with pseudoexfoliation of lens, left eye, moderate stage

H40.1423 Capsular glaucoma with pseudoexfoliation of lens, left eye, severe stage

H40.1424 Capsular glaucoma with pseudoexfoliation of lens, left eye, indeterminate stage

H40.1431 Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stage

H40.1432 Capsular glaucoma with pseudoexfoliation of lens, bilateral, moderate stage

H40.1433 Capsular glaucoma with pseudoexfoliation of lens, bilateral, severe stage

H40.1434 Capsular glaucoma with pseudoexfoliation of lens, bilateral, indeterminate stage

H40.211 Acute angle-closure glaucoma, right eye

H40.212 Acute angle-closure glaucoma, left eye

H40.213 Acute angle-closure glaucoma, bilateral

H40.219 Acute angle-closure glaucoma, unspecified eye

H40.2211 Chronic angle-closure glaucoma, right eye, mild stage

H40.2212 Chronic angle-closure glaucoma, right eye, moderate stage

H40.2213 Chronic angle-closure glaucoma, right eye, severe stage

H40.2214 Chronic angle-closure glaucoma, right eye, indeterminate stage

H40.2221 Chronic angle-closure glaucoma, left eye, mild stage

H40.2222 Chronic angle-closure glaucoma, left eye, moderate stage

H40.2223 Chronic angle-closure glaucoma, left eye, severe stage

H40.2224 Chronic angle-closure glaucoma, left eye, indeterminate stage

H40.2231 Chronic angle-closure glaucoma, bilateral, mild stage

H40.2232 Chronic angle-closure glaucoma, bilateral, moderate stage

H40.2233 Chronic angle-closure glaucoma, bilateral, severe stage

H40.2234 Chronic angle-closure glaucoma, bilateral, indeterminate stage

H40.231 Intermittent angle-closure glaucoma, right eye

H40.232 Intermittent angle-closure glaucoma, left eye

H40.233 Intermittent angle-closure glaucoma, bilateral

H40.239 Intermittent angle-closure glaucoma, unspecified eye

H40.241 Residual stage of angle-closure glaucoma, right eye

H40.242 Residual stage of angle-closure glaucoma, left eye

H40.243 Residual stage of angle-closure glaucoma, bilateral

H40.249 Residual stage of angle-closure glaucoma, unspecified eye

H40.31X1 Glaucoma secondary to eye trauma, right eye, mild stage

H40.31X2 Glaucoma secondary to eye trauma, right eye, moderate stage

H40.31X3 Glaucoma secondary to eye trauma, right eye, severe stage

H40.31X4 Glaucoma secondary to eye trauma, right eye, indeterminate stage

H40.32X1 Glaucoma secondary to eye trauma, left eye, mild stage

H40.32X2 Glaucoma secondary to eye trauma, left eye, moderate stage

H40.32X3 Glaucoma secondary to eye trauma, left eye, severe stage

H40.32X4 Glaucoma secondary to eye trauma, left eye, indeterminate stage

H40.33X1 Glaucoma secondary to eye trauma, bilateral, mild stage

H40.33X2 Glaucoma secondary to eye trauma, bilateral, moderate stage

H40.33X3 Glaucoma secondary to eye trauma, bilateral, severe stage

H40.33X4 Glaucoma secondary to eye trauma, bilateral, indeterminate stage

H40.41X1 Glaucoma secondary to eye inflammation, right eye, mild stage

H40.41X2 Glaucoma secondary to eye inflammation, right eye, moderate stage

H40.41X3 Glaucoma secondary to eye inflammation, right eye, severe stage

H40.41X4 Glaucoma secondary to eye inflammation, right eye, indeterminate stage

H40.42X1 Glaucoma secondary to eye inflammation, left eye, mild stage

H40.42X2 Glaucoma secondary to eye inflammation, left eye, moderate stage

H40.42X3 Glaucoma secondary to eye inflammation, left eye, severe stage

H40.42X4 Glaucoma secondary to eye inflammation, left eye, indeterminate stage

H40.43X1 Glaucoma secondary to eye inflammation, bilateral, mild stage

H40.43X2 Glaucoma secondary to eye inflammation, bilateral, moderate stage

H40.43X3 Glaucoma secondary to eye inflammation, bilateral, severe stage

H40.43X4 Glaucoma secondary to eye inflammation, bilateral, indeterminate stage

H40.50X1 Glaucoma secondary to other eye disorders, unspecified eye, mild stage

H40.50X2 Glaucoma secondary to other eye disorders, unspecified eye, moderate stage

H40.50X3 Glaucoma secondary to other eye disorders, unspecified eye, severe stage

H40.50X4 Glaucoma secondary to other eye disorders, unspecified eye, indeterminate stage

H40.51X1 Glaucoma secondary to other eye disorders, right eye, mild stage

H40.51X2 Glaucoma secondary to other eye disorders, right eye, moderate stage

H40.51X3 Glaucoma secondary to other eye disorders, right eye, severe stage

H40.51X4 Glaucoma secondary to other eye disorders, right eye, indeterminate stage

H40.52X1 Glaucoma secondary to other eye disorders, left eye, mild stage

H40.52X2 Glaucoma secondary to other eye disorders, left eye, moderate stage

H40.52X3 Glaucoma secondary to other eye disorders, left eye, severe stage

H40.52X4 Glaucoma secondary to other eye disorders, left eye, indeterminate stage

H40.53X1 Glaucoma secondary to other eye disorders, bilateral, mild stage

H40.53X2 Glaucoma secondary to other eye disorders, bilateral, moderate stage

H40.53X3 Glaucoma secondary to other eye disorders, bilateral, severe stage

H40.53X4 Glaucoma secondary to other eye disorders, bilateral, indeterminate stage

H40.61X1 Glaucoma secondary to drugs, right eye, mild stage

H40.61X2 Glaucoma secondary to drugs, right eye, moderate stage

H40.61X3 Glaucoma secondary to drugs, right eye, severe stage

H40.61X4 Glaucoma secondary to drugs, right eye, indeterminate stage

H40.62X1 Glaucoma secondary to drugs, left eye, mild stage

H40.62X2 Glaucoma secondary to drugs, left eye, moderate stage

H40.62X3 Glaucoma secondary to drugs, left eye, severe stage

H40.62X4 Glaucoma secondary to drugs, left eye, indeterminate stage

H40.63X1 Glaucoma secondary to drugs, bilateral, mild stage

H40.63X2 Glaucoma secondary to drugs, bilateral, moderate stage

H40.63X3 Glaucoma secondary to drugs, bilateral, severe stage

H40.63X4 Glaucoma secondary to drugs, bilateral, indeterminate stage

H40.811 Glaucoma with increased episcleral venous pressure, right eye

H40.812 Glaucoma with increased episcleral venous pressure, left eye

H40.813 Glaucoma with increased episcleral venous pressure, bilateral

H40.819 Glaucoma with increased episcleral venous pressure, unspecified eye

H40.821 Hypersecretion glaucoma, right eye

H40.822 Hypersecretion glaucoma, left eye

H40.823 Hypersecretion glaucoma, bilateral

H40.829 Hypersecretion glaucoma, unspecified eye

H40.831 Aqueous misdirection, right eye

H40.832 Aqueous misdirection, left eye

H40.833 Aqueous misdirection, bilateral

H40.839 Aqueous misdirection, unspecified eye

H40.89 Other specified glaucoma

H46.00 Optic papillitis, unspecified eye

H46.01 Optic papillitis, right eye

H46.02 Optic papillitis, left eye

H46.03 Optic papillitis, bilateral

H46.10 Retrobulbar neuritis, unspecified eye

H46.11 Retrobulbar neuritis, right eye

H46.12 Retrobulbar neuritis, left eye

H46.13 Retrobulbar neuritis, bilateral

H46.8 Other optic neuritis

H47.011 Ischemic optic neuropathy, right eye

H47.012 Ischemic optic neuropathy, left eye

H47.013 Ischemic optic neuropathy, bilateral

H47.019 Ischemic optic neuropathy, unspecified eye

H47.031 Optic nerve hypoplasia, right eye

H47.032 Optic nerve hypoplasia, left eye

H47.033 Optic nerve hypoplasia, bilateral

H47.039 Optic nerve hypoplasia, unspecified eye

H47.11 Papilledema associated with increased intracranial pressure

H47.12 Papilledema associated with decreased ocular pressure

H47.13 Papilledema associated with retinal disorder

H47.141 Foster-Kennedy syndrome, right eye

H47.142 Foster-Kennedy syndrome, left eye

H47.143 Foster-Kennedy syndrome, bilateral

H47.149 Foster-Kennedy syndrome, unspecified eye

H47.211 Primary optic atrophy, right eye

H47.212 Primary optic atrophy, left eye

H47.213 Primary optic atrophy, bilateral

H47.219 Primary optic atrophy, unspecified eye

H47.231 Glaucomatous optic atrophy, right eye

H47.232 Glaucomatous optic atrophy, left eye

H47.233 Glaucomatous optic atrophy, bilateral

H47.239 Glaucomatous optic atrophy, unspecified eye

H47.291 Other optic atrophy, right eye

H47.292 Other optic atrophy, left eye

H47.293 Other optic atrophy, bilateral

H47.299 Other optic atrophy, unspecified eye

H47.321 Drusen of optic disc, right eye

H47.322 Drusen of optic disc, left eye

H47.323 Drusen of optic disc, bilateral

H47.329 Drusen of optic disc, unspecified eye

H47.331 Pseudopapilledema of optic disc, right eye

H47.332 Pseudopapilledema of optic disc, left eye

H47.333 Pseudopapilledema of optic disc, bilateral

H47.339 Pseudopapilledema of optic disc, unspecified eye

H47.391 Other disorders of optic disc, right eye

H47.392 Other disorders of optic disc, left eye

H47.393 Other disorders of optic disc, bilateral

H47.399 Other disorders of optic disc, unspecified eye

H53.15 Visual distortions of shape and size

H53.411 Scotoma involving central area, right eye

H53.412 Scotoma involving central area, left eye

H53.413 Scotoma involving central area, bilateral

H53.419 Scotoma involving central area, unspecified eye

H53.421 Scotoma of blind spot area, right eye

H53.422 Scotoma of blind spot area, left eye

H53.423 Scotoma of blind spot area, bilateral

H53.429 Scotoma of blind spot area, unspecified eye

H53.431 Sector or arcuate defects, right eye

H53.432 Sector or arcuate defects, left eye

H53.433 Sector or arcuate defects, bilateral

H53.439 Sector or arcuate defects, unspecified eye

H53.451 Other localized visual field defect, right eye

H53.452 Other localized visual field defect, left eye

H53.453 Other localized visual field defect, bilateral

H53.459 Other localized visual field defect, unspecified eye

H53.481 Generalized contraction of visual field, right eye

H53.482 Generalized contraction of visual field, left eye

H53.483 Generalized contraction of visual field, bilateral

H53.489 Generalized contraction of visual field, unspecified eye

Q15.0 Congenital glaucoma

THE FOLLOWING CODES ARE CONSIDERED MEDICALLY NECESSARY WHEN REPORTED WITH 92134

A18.53 Tuberculous chorioretinitis

B39.4 Histoplasmosis capsulati, unspecified

C69.20 Malignant neoplasm of unspecified retina

C69.21 Malignant neoplasm of right retina

C69.22 Malignant neoplasm of left retina

C69.30 Malignant neoplasm of unspecified choroid

C69.31 Malignant neoplasm of right choroid

C69.32 Malignant neoplasm of left choroid

D31.30 Benign neoplasm of unspecified choroid

D31.31 Benign neoplasm of right choroid

D31.32 Benign neoplasm of left choroid

E08.3211 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye

E08.3212 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye

E08.3213 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral

E08.3219 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye

E08.3291 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye

E08.3292 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye

E08.3293 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral

E08.3299 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye

E08.3311 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye

E08.3312 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye

E08.3313 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral

E08.3319 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye

E08.3391 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye

E08.3392 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye

E08.3393 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral

E08.3399 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye

E08.3411 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye

E08.3412 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye

E08.3413 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral

E08.3419 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye

E08.3491 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, right eye

E08.3492 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye

E08.3493 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral

E08.3499 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye

E08.3511 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye

E08.3512 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye

E08.3513 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral

E08.3519 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye

E08.3521 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye

E08.3522 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye

E08.3523 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral

E08.3529 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye

E08.3531 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye

E08.3532 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye

E08.3533 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral

E08.3539 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye

E08.3541 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye

E08.3542 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye

E08.3543 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral

E08.3549 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye

E08.3551 Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye

E08.3552 Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye

E08.3553 Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral

E08.3559 Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye

E08.3591 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye

E08.3592 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye

E08.3593 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral

E08.3599 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye

E08.37X1 Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye

E08.37X2 Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, left eye

E08.37X3 Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, bilateral

E08.37X9 Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, unspecified eye

E09.3211 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye

E09.3212 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye

E09.3213 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral

E09.3219 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye

E09.3291 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye

E09.3292 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye

E09.3293 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral

E09.3299 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye

E09.3311 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye

E09.3312 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye

E09.3313 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral

E09.3319 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye

E09.3391 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye

E09.3392 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye

E09.3393 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral

E09.3399 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye

E09.3411 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye

E09.3412 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye

E09.3413 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral

E09.3419 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye

E09.3491 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye

E09.3492 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye

E09.3493 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral

E09.3499 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye

E09.3511 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye

E09.3512 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye

E09.3513 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral

E09.3519 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye

E09.3521 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye

E09.3522 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye

E09.3523 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral

E09.3529 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye

E09.3531 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye

E09.3532 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye

E09.3533 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral

E09.3539 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye

E09.3541 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye

E09.3542 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye

E09.3543 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral

E09.3549 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye

E09.3551 Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye

E09.3552 Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye

E09.3553 Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral

E09.3559 Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye

E09.3591 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye

E09.3592 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye

E09.3593 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral

E09.3599 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye

E09.37X1 Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye

E09.37X2 Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, left eye

E09.37X3 Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral

E09.37X9 Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye

E10.3211 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye

E10.3212 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye

E10.3213 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral

E10.3219 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye

E10.3291 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye

E10.3292 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye

E10.3293 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral

E10.3299 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye

E10.3311 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye

E10.3312 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye

E10.3313 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral

E10.3319 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye

E10.3391 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye

E10.3392 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye

E10.3393 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral

E10.3399 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye

E10.3411 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye

E10.3412 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye

E10.3413 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral

E10.3419 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye

E10.3491 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye

E10.3492 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye

E10.3493 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral

E10.3499 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye

E10.3511 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye

E10.3512 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye

E10.3513 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral

E10.3519 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye

E10.3521 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye

E10.3522 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye

E10.3523 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral

E10.3529 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye

E10.3531 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye

E10.3532 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye

E10.3533 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral

E10.3539 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye

E10.3541 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye

E10.3542 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye

E10.3543 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral

E10.3549 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye

E10.3551 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye

E10.3552 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye

E10.3553 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral

E10.3559 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye

E10.3591 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye

E10.3592 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye

E10.3593 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral

E10.3599 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye

E10.37X1 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye

E10.37X2 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye

E10.37X3 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral

E10.37X9 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye

E11.3211 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye

E11.3212 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye

E11.3213 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral

E11.3219 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye

E11.3291 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye

E11.3292 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye

E11.3293 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral

E11.3299 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye

E11.3311 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye

E11.3312 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye

E11.3313 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral

E11.3319 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye

E11.3391 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye

E11.3392 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye

E11.3393 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral

E11.3399 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye

E11.3411 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye

E11.3412 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye

E11.3413 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral

E11.3419 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye

E11.3491 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye

E11.3492 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye

E11.3493 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral

E11.3499 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye

E11.3511 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye

E11.3512 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye

E11.3513 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral

E11.3519 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye

E11.3521 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye

E11.3522 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye

E11.3523 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral

E11.3529 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye

E11.3531 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye

E11.3532 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye

E11.3533 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral

E11.3539 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye

E11.3541 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye

E11.3542 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye

E11.3543 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral

E11.3549 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye

E11.3551 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye

E11.3552 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye

E11.3553 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral

E11.3559 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye

E11.3591 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye

E11.3592 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye

E11.3593 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral

E11.3599 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye

E11.37X1 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye

E11.37X2 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye

E11.37X3 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral

E11.37X9 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye

E13.3211 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye

E13.3212 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye

E13.3213 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral

E13.3219 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye

E13.3291 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye

E13.3292 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye

E13.3293 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral

E13.3299 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye

E13.3311 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye

E13.3312 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye

E13.3313 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral

E13.3319 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye

E13.3391 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye

E13.3392 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye

E13.3393 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral

E13.3399 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye

E13.3411 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye

E13.3412 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye

E13.3413 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral

E13.3419 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye

E13.3491 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye

E13.3492 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye

E13.3493 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral

E13.3499 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye

E13.3511 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye

E13.3512 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye

E13.3513 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral

E13.3519 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye

E13.3521 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye

E13.3522 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye

E13.3523 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral

E13.3529 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye

E13.3531 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye

E13.3532 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye

E13.3533 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral

E13.3539 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye

E13.3541 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye

E13.3542 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye

E13.3543 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral

E13.3549 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye

E13.3551 Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye

E13.3552 Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye

E13.3553 Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral

E13.3559 Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye

E13.3591 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye

E13.3592 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye

E13.3593 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral

E13.3599 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye

E13.37X1 Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, right eye

E13.37X2 Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, left eye

E13.37X3 Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral

E13.37X9 Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye

G45.3 Amaurosis fugax

H30.011 Focal chorioretinal inflammation, juxtapapillary, right eye

H30.012 Focal chorioretinal inflammation, juxtapapillary, left eye

H30.013 Focal chorioretinal inflammation, juxtapapillary, bilateral

H30.019 Focal chorioretinal inflammation, juxtapapillary, unspecified eye

H30.021 Focal chorioretinal inflammation of posterior pole, right eye

H30.022 Focal chorioretinal inflammation of posterior pole, left eye

H30.023 Focal chorioretinal inflammation of posterior pole, bilateral

H30.029 Focal chorioretinal inflammation of posterior pole, unspecified eye

H30.031 Focal chorioretinal inflammation, peripheral, right eye

H30.032 Focal chorioretinal inflammation, peripheral, left eye

H30.033 Focal chorioretinal inflammation, peripheral, bilateral

H30.039 Focal chorioretinal inflammation, peripheral, unspecified eye

H30.041 Focal chorioretinal inflammation, macular or paramacular, right eye

H30.042 Focal chorioretinal inflammation, macular or paramacular, left eye

H30.043 Focal chorioretinal inflammation, macular or paramacular, bilateral

H30.049 Focal chorioretinal inflammation, macular or paramacular, unspecified eye

H30.111 Disseminated chorioretinal inflammation of posterior pole, right eye

H30.112 Disseminated chorioretinal inflammation of posterior pole, left eye

H30.113 Disseminated chorioretinal inflammation of posterior pole, bilateral

H30.119 Disseminated chorioretinal inflammation of posterior pole, unspecified eye

H30.121 Disseminated chorioretinal inflammation, peripheral right eye

H30.122 Disseminated chorioretinal inflammation, peripheral, left eye

H30.123 Disseminated chorioretinal inflammation, peripheral, bilateral

H30.129 Disseminated chorioretinal inflammation, peripheral, unspecified eye

H30.131 Disseminated chorioretinal inflammation, generalized, right eye

H30.132 Disseminated chorioretinal inflammation, generalized, left eye

H30.133 Disseminated chorioretinal inflammation, generalized, bilateral

H30.139 Disseminated chorioretinal inflammation, generalized, unspecified eye

H30.141 Acute posterior multifocal placoid pigment epitheliopathy, right eye

H30.142 Acute posterior multifocal placoid pigment epitheliopathy, left eye

H30.143 Acute posterior multifocal placoid pigment epitheliopathy, bilateral

H30.149 Acute posterior multifocal placoid pigment epitheliopathy, unspecified eye

H30.20 Posterior cyclitis, unspecified eye

H30.21 Posterior cyclitis, right eye

H30.22 Posterior cyclitis, left eye

H30.23 Posterior cyclitis, bilateral

H30.811 Harada's disease, right eye

H30.812 Harada's disease, left eye

H30.813 Harada's disease, bilateral

H30.819 Harada's disease, unspecified eye

H30.891 Other chorioretinal inflammations, right eye

H30.892 Other chorioretinal inflammations, left eye

H30.893 Other chorioretinal inflammations, bilateral

H30.899 Other chorioretinal inflammations, unspecified eye

H31.021 Solar retinopathy, right eye

H31.022 Solar retinopathy, left eye

H31.023 Solar retinopathy, bilateral

H31.029 Solar retinopathy, unspecified eye

H31.101 Choroidal degeneration, unspecified, right eye

H31.102 Choroidal degeneration, unspecified, left eye

H31.103 Choroidal degeneration, unspecified, bilateral

H31.109 Choroidal degeneration, unspecified, unspecified eye

H31.111 Age-related choroidal atrophy, right eye

H31.112 Age-related choroidal atrophy, left eye

H31.113 Age-related choroidal atrophy, bilateral

H31.119 Age-related choroidal atrophy, unspecified eye

H31.121 Diffuse secondary atrophy of choroid, right eye

H31.122 Diffuse secondary atrophy of choroid, left eye

H31.123 Diffuse secondary atrophy of choroid, bilateral

H31.129 Diffuse secondary atrophy of choroid, unspecified eye

H31.411 Hemorrhagic choroidal detachment, right eye

H31.412 Hemorrhagic choroidal detachment, left eye

H31.413 Hemorrhagic choroidal detachment, bilateral

H31.419 Hemorrhagic choroidal detachment, unspecified eye

H31.421 Serous choroidal detachment, right eye

H31.422 Serous choroidal detachment, left eye

H31.423 Serous choroidal detachment, bilateral

H31.429 Serous choroidal detachment, unspecified eye

H32 Chorioretinal disorders in diseases classified elsewhere

H33.011 Retinal detachment with single break, right eye

H33.012 Retinal detachment with single break, left eye

H33.013 Retinal detachment with single break, bilateral

H33.019 Retinal detachment with single break, unspecified eye

H33.021 Retinal detachment with multiple breaks, right eye

H33.022 Retinal detachment with multiple breaks, left eye

H33.023 Retinal detachment with multiple breaks, bilateral

H33.029 Retinal detachment with multiple breaks, unspecified eye

H33.031 Retinal detachment with giant retinal tear, right eye

H33.032 Retinal detachment with giant retinal tear, left eye

H33.033 Retinal detachment with giant retinal tear, bilateral

H33.039 Retinal detachment with giant retinal tear, unspecified eye

H33.041 Retinal detachment with retinal dialysis, right eye

H33.042 Retinal detachment with retinal dialysis, left eye

H33.043 Retinal detachment with retinal dialysis, bilateral

H33.049 Retinal detachment with retinal dialysis, unspecified eye

H33.051 Total retinal detachment, right eye

H33.052 Total retinal detachment, left eye

H33.053 Total retinal detachment, bilateral

H33.059 Total retinal detachment, unspecified eye

H33.111 Cyst of ora serrata, right eye

H33.112 Cyst of ora serrata, left eye

H33.113 Cyst of ora serrata, bilateral

H33.119 Cyst of ora serrata, unspecified eye

H33.191 Other retinoschisis and retinal cysts, right eye

H33.192 Other retinoschisis and retinal cysts, left eye

H33.193 Other retinoschisis and retinal cysts, bilateral

H33.199 Other retinoschisis and retinal cysts, unspecified eye

H33.20 Serous retinal detachment, unspecified eye

H33.21 Serous retinal detachment, right eye

H33.22 Serous retinal detachment, left eye

H33.23 Serous retinal detachment, bilateral

H33.311 Horseshoe tear of retina without detachment, right eye

H33.312 Horseshoe tear of retina without detachment, left eye

H33.313 Horseshoe tear of retina without detachment, bilateral

H33.319 Horseshoe tear of retina without detachment, unspecified eye

H33.321 Round hole, right eye

H33.322 Round hole, left eye

H33.323 Round hole, bilateral

H33.329 Round hole, unspecified eye

H33.331 Multiple defects of retina without detachment, right eye

H33.332 Multiple defects of retina without detachment, left eye

H33.333 Multiple defects of retina without detachment, bilateral

H33.339 Multiple defects of retina without detachment, unspecified eye

H33.40 Traction detachment of retina, unspecified eye

H33.41 Traction detachment of retina, right eye

H33.42 Traction detachment of retina, left eye

H33.43 Traction detachment of retina, bilateral

H33.8 Other retinal detachments

H34.00 Transient retinal artery occlusion, unspecified eye

H34.01 Transient retinal artery occlusion, right eye

H34.02 Transient retinal artery occlusion, left eye

H34.03 Transient retinal artery occlusion, bilateral

H34.10 Central retinal artery occlusion, unspecified eye

H34.11 Central retinal artery occlusion, right eye

H34.12 Central retinal artery occlusion, left eye

H34.13 Central retinal artery occlusion, bilateral

H34.211 Partial retinal artery occlusion, right eye

H34.212 Partial retinal artery occlusion, left eye

H34.213 Partial retinal artery occlusion, bilateral

H34.219 Partial retinal artery occlusion, unspecified eye

H34.231 Retinal artery branch occlusion, right eye

H34.232 Retinal artery branch occlusion, left eye

H34.233 Retinal artery branch occlusion, bilateral

H34.239 Retinal artery branch occlusion, unspecified eye

H34.8110 Central retinal vein occlusion, right eye, with macular edema

H34.8111 Central retinal vein occlusion, right eye, with retinal neovascularization

H34.8112 Central retinal vein occlusion, right eye, stable

H34.8120 Central retinal vein occlusion, left eye, with macular edema

H34.8121 Central retinal vein occlusion, left eye, with retinal neovascularization

H34.8122 Central retinal vein occlusion, left eye, stable

H34.8130 Central retinal vein occlusion, bilateral, with macular edema

H34.8131 Central retinal vein occlusion, bilateral, with retinal neovascularization

H34.8132 Central retinal vein occlusion, bilateral, stable

H34.8190 Central retinal vein occlusion, unspecified eye, with macular edema

H34.8191 Central retinal vein occlusion, unspecified eye, with retinal neovascularization

H34.8192 Central retinal vein occlusion, unspecified eye, stable

H34.821 Venous engorgement, right eye

H34.822 Venous engorgement, left eye

H34.823 Venous engorgement, bilateral

H34.829 Venous engorgement, unspecified eye

H34.8310 Tributary (branch) retinal vein occlusion, right eye, with macular edema

H34.8311 Tributary (branch) retinal vein occlusion, right eye, with retinal neovascularization

H34.8312 Tributary (branch) retinal vein occlusion, right eye, stable

H34.8320 Tributary (branch) retinal vein occlusion, left eye, with macular edema

H34.8321 Tributary (branch) retinal vein occlusion, left eye, with retinal neovascularization

H34.8322 Tributary (branch) retinal vein occlusion, left eye, stable

H34.8330 Tributary (branch) retinal vein occlusion, bilateral, with macular edema

H34.8331 Tributary (branch) retinal vein occlusion, bilateral, with retinal neovascularization

H34.8332 Tributary (branch) retinal vein occlusion, bilateral, stable

H35.011 Changes in retinal vascular appearance, right eye

H35.012 Changes in retinal vascular appearance, left eye

H35.013 Changes in retinal vascular appearance, bilateral

H35.019 Changes in retinal vascular appearance, unspecified eye

H35.021 Exudative retinopathy, right eye

H35.022 Exudative retinopathy, left eye

H35.023 Exudative retinopathy, bilateral

H35.029 Exudative retinopathy, unspecified eye

H35.031 Hypertensive retinopathy, right eye

H35.032 Hypertensive retinopathy, left eye

H35.033 Hypertensive retinopathy, bilateral

H35.039 Hypertensive retinopathy, unspecified eye

H35.041 Retinal micro-aneurysms, unspecified, right eye

H35.042 Retinal micro-aneurysms, unspecified, left eye

H35.043 Retinal micro-aneurysms, unspecified, bilateral

H35.049 Retinal micro-aneurysms, unspecified, unspecified eye

H35.051 Retinal neovascularization, unspecified, right eye

H35.052 Retinal neovascularization, unspecified, left eye

H35.053 Retinal neovascularization, unspecified, bilateral

H35.059 Retinal neovascularization, unspecified, unspecified eye

H35.061 Retinal vasculitis, right eye

H35.062 Retinal vasculitis, left eye

H35.063 Retinal vasculitis, bilateral

H35.069 Retinal vasculitis, unspecified eye

H35.071 Retinal telangiectasis, right eye

H35.072 Retinal telangiectasis, left eye

H35.073 Retinal telangiectasis, bilateral

H35.079 Retinal telangiectasis, unspecified eye

H35.09 Other intraretinal microvascular abnormalities

H35.171 Retrolental fibroplasia, right eye

H35.172 Retrolental fibroplasia, left eye

H35.173 Retrolental fibroplasia, bilateral

H35.179 Retrolental fibroplasia, unspecified eye

H35.20 Other non-diabetic proliferative retinopathy, unspecified eye

H35.21 Other non-diabetic proliferative retinopathy, right eye

H35.22 Other non-diabetic proliferative retinopathy, left eye

H35.23 Other non-diabetic proliferative retinopathy, bilateral

H35.3110 Nonexudative age-related macular degeneration, right eye, stage unspecified

H35.3111 Nonexudative age-related macular degeneration, right eye, early dry stage

H35.3112 Nonexudative age-related macular degeneration, right eye, intermediate dry stage

H35.3113 Nonexudative age-related macular degeneration, right eye, advanced atrophic without subfoveal involvement

H35.3114 Nonexudative age-related macular degeneration, right eye, advanced atrophic with subfoveal involvement

H35.3120 Nonexudative age-related macular degeneration, left eye, stage unspecified

H35.3121 Nonexudative age-related macular degeneration, left eye, early dry stage

H35.3122 Nonexudative age-related macular degeneration, left eye, intermediate dry stage

H35.3123 Nonexudative age-related macular degeneration, left eye, advanced atrophic without subfoveal involvement

H35.3124 Nonexudative age-related macular degeneration, left eye, advanced atrophic with subfoveal involvement

H35.3130 Nonexudative age-related macular degeneration, bilateral, stage unspecified

H35.3131 Nonexudative age-related macular degeneration, bilateral, early dry stage

H35.3132 Nonexudative age-related macular degeneration, bilateral, intermediate dry stage

H35.3133 Nonexudative age-related macular degeneration, bilateral, advanced atrophic without subfoveal involvement

H35.3134 Nonexudative age-related macular degeneration, bilateral, advanced atrophic with subfoveal involvement

H35.3210 Exudative age-related macular degeneration, right eye, stage unspecified

H35.3211 Exudative age-related macular degeneration, right eye, with active choroidal neovascularization

H35.3212 Exudative age-related macular degeneration, right eye, with inactive choroidal neovascularization

H35.3213 Exudative age-related macular degeneration, right eye, with inactive scar

H35.3220 Exudative age-related macular degeneration, left eye, stage unspecified

H35.3221 Exudative age-related macular degeneration, left eye, with active choroidal neovascularization

H35.3222 Exudative age-related macular degeneration, left eye, with inactive choroidal neovascularization

H35.3223 Exudative age-related macular degeneration, left eye, with inactive scar

H35.3230 Exudative age-related macular degeneration, bilateral, stage unspecified

H35.3231 Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization

H35.3232 Exudative age-related macular degeneration, bilateral, with inactive choroidal neovascularization

H35.3233 Exudative age-related macular degeneration, bilateral, with inactive scar

H35.33 Angioid streaks of macula

H35.341 Macular cyst, hole, or pseudohole, right eye

H35.342 Macular cyst, hole, or pseudohole, left eye

H35.343 Macular cyst, hole, or pseudohole, bilateral

H35.349 Macular cyst, hole, or pseudohole, unspecified eye

H35.351 Cystoid macular degeneration, right eye

H35.352 Cystoid macular degeneration, left eye

H35.353 Cystoid macular degeneration, bilateral

H35.359 Cystoid macular degeneration, unspecified eye

H35.361 Drusen (degenerative) of macula, right eye

H35.362 Drusen (degenerative) of macula, left eye

H35.363 Drusen (degenerative) of macula, bilateral

H35.369 Drusen (degenerative) of macula, unspecified eye

H35.371 Puckering of macula, right eye

H35.372 Puckering of macula, left eye

H35.373 Puckering of macula, bilateral

H35.379 Puckering of macula, unspecified eye

H35.381 Toxic maculopathy, right eye

H35.382 Toxic maculopathy, left eye

H35.383 Toxic maculopathy, bilateral

H35.389 Toxic maculopathy, unspecified eye

H35.40 Unspecified peripheral retinal degeneration

H35.411 Lattice degeneration of retina, right eye

H35.412 Lattice degeneration of retina, left eye

H35.413 Lattice degeneration of retina, bilateral

H35.419 Lattice degeneration of retina, unspecified eye

H35.421 Microcystoid degeneration of retina, right eye

H35.422 Microcystoid degeneration of retina, left eye

H35.423 Microcystoid degeneration of retina, bilateral

H35.429 Microcystoid degeneration of retina, unspecified eye

H35.431 Paving stone degeneration of retina, right eye

H35.432 Paving stone degeneration of retina, left eye

H35.433 Paving stone degeneration of retina, bilateral

H35.439 Paving stone degeneration of retina, unspecified eye

H35.441 Age-related reticular degeneration of retina, right eye

H35.442 Age-related reticular degeneration of retina, left eye

H35.443 Age-related reticular degeneration of retina, bilateral

H35.449 Age-related reticular degeneration of retina, unspecified eye

H35.451 Secondary pigmentary degeneration, right eye

H35.452 Secondary pigmentary degeneration, left eye

H35.453 Secondary pigmentary degeneration, bilateral

H35.459 Secondary pigmentary degeneration, unspecified eye

H35.461 Secondary vitreoretinal degeneration, right eye

H35.462 Secondary vitreoretinal degeneration, left eye

H35.463 Secondary vitreoretinal degeneration, bilateral

H35.469 Secondary vitreoretinal degeneration, unspecified eye

H35.50 Unspecified hereditary retinal dystrophy

H35.51 Vitreoretinal dystrophy

H35.52 Pigmentary retinal dystrophy

H35.53 Other dystrophies primarily involving the sensory retina

H35.54 Dystrophies primarily involving the retinal pigment epithelium

H35.60 Retinal hemorrhage, unspecified eye

H35.61 Retinal hemorrhage, right eye

H35.62 Retinal hemorrhage, left eye

H35.63 Retinal hemorrhage, bilateral

H35.70 Unspecified separation of retinal layers

H35.711 Central serous chorioretinopathy, right eye

H35.712 Central serous chorioretinopathy, left eye

H35.713 Central serous chorioretinopathy, bilateral

H35.719 Central serous chorioretinopathy, unspecified eye

H35.721 Serous detachment of retinal pigment epithelium, right eye

H35.722 Serous detachment of retinal pigment epithelium, left eye

H35.723 Serous detachment of retinal pigment epithelium, bilateral

H35.729 Serous detachment of retinal pigment epithelium, unspecified eye

H35.731 Hemorrhagic detachment of retinal pigment epithelium, right eye

H35.732 Hemorrhagic detachment of retinal pigment epithelium, left eye

H35.733 Hemorrhagic detachment of retinal pigment epithelium, bilateral

H35.739 Hemorrhagic detachment of retinal pigment epithelium, unspecified eye

H35.81 Retinal edema

H35.82 Retinal ischemia

H35.89 Other specified retinal disorders

H40.831 Aqueous misdirection, right eye

H40.832 Aqueous misdirection, left eye

H40.833 Aqueous misdirection, bilateral

H40.839 Aqueous misdirection, unspecified eye

H40.89 Other specified glaucoma

H43.811 Vitreous degeneration, right eye

H43.812 Vitreous degeneration, left eye

H43.813 Vitreous degeneration, bilateral

H43.819 Vitreous degeneration, unspecified eye

H43.821 Vitreomacular adhesion, right eye

H43.822 Vitreomacular adhesion, left eye

H43.823 Vitreomacular adhesion, bilateral

H43.829 Vitreomacular adhesion, unspecified eye

H44.2A1 Degenerative myopia with choroidal neovascularization, right eye

H44.2A2 Degenerative myopia with choroidal neovascularization, left eye

H44.2A3 Degenerative myopia with choroidal neovascularization, bilateral eye

H44.2A9 Degenerative myopia with choroidal neovascularization, unspecified eye

H44.2B1 Degenerative myopia with macular hole, right eye

H44.2B2 Degenerative myopia with macular hole, left eye

H44.2B3 Degenerative myopia with macular hole, bilateral eye

H44.2B9 Degenerative myopia with macular hole, unspecified eye

H44.2C1 Degenerative myopia with retinal detachment, right eye

H44.2C2 Degenerative myopia with retinal detachment, left eye

H44.2C3 Degenerative myopia with retinal detachment, bilateral eye

H44.2C9 Degenerative myopia with retinal detachment, unspecified eye

H44.2D1 Degenerative myopia with foveoschisis, right eye

H44.2D2 Degenerative myopia with foveoschisis, left eye

H44.2D3 Degenerative myopia with foveoschisis, bilateral eye

H44.2D9 Degenerative myopia with foveoschisis, unspecified eye

H44.2E1 Degenerative myopia with other maculopathy, right eye

H44.2E2 Degenerative myopia with other maculopathy, left eye

H44.2E3 Degenerative myopia with other maculopathy, bilateral eye

H44.2E9 Degenerative myopia with other maculopathy, unspecified eye

H47.11 Papilledema associated with increased intracranial pressure

H47.12 Papilledema associated with decreased ocular pressure

H47.13 Papilledema associated with retinal disorder

H47.141 Foster-Kennedy syndrome, right eye

H47.142 Foster-Kennedy syndrome, left eye

H47.143 Foster-Kennedy syndrome, bilateral

H47.149 Foster-Kennedy syndrome, unspecified eye

H53.15 Visual distortions of shape and size

H53.411 Scotoma involving central area, right eye

H53.412 Scotoma involving central area, left eye

H53.413 Scotoma involving central area, bilateral

H53.419 Scotoma involving central area, unspecified eye

H53.421 Scotoma of blind spot area, right eye

H53.422 Scotoma of blind spot area, left eye

H53.423 Scotoma of blind spot area, bilateral

H53.429 Scotoma of blind spot area, unspecified eye

H53.431 Sector or arcuate defects, right eye

H53.432 Sector or arcuate defects, left eye

H53.433 Sector or arcuate defects, bilateral

H53.439 Sector or arcuate defects, unspecified eye

H53.451 Other localized visual field defect, right eye

H53.452 Other localized visual field defect, left eye

H53.453 Other localized visual field defect, bilateral

H53.459 Other localized visual field defect, unspecified eye

H53.481 Generalized contraction of visual field, right eye

H53.482 Generalized contraction of visual field, left eye

H53.483 Generalized contraction of visual field, bilateral

H53.489 Generalized contraction of visual field, unspecified eye

H59.031 Cystoid macular edema following cataract surgery, right eye

H59.032 Cystoid macular edema following cataract surgery, left eye

H59.033 Cystoid macular edema following cataract surgery, bilateral

Z79.899 Other long term (current) drug therapy




HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements



Policy History

Revisions from 07.13.06k
09/10/2018As part of the update, medical necessity criteria are being amended as follows:
  • The conditions covered for anterior segment evaluation include specified forms of glaucoma and certain disorders of the cornea, iris and ciliary body.
  • The conditions covered for posterior segment evaluation include conditions affecting the optic nerve (e.g., optic neuropathy) or retinal disease (e.g., macular degeneration, diabetic retinopathy) and certain macular abnormalities (e.g., macular edema, atrophy associated with degenerative retinal diseases).
  • The covered retinal conditions in active treatment for which one exam, per eye, per month may be appropriate include wet age-related macular degeneration (AMD), choroidal neovascularization, macular edema, diabetic retinopathy (proliferative and nonproliferative), branch retinal vein occlusion, central retinal vein occlusion, and cystoid macular edema.
  • The timing of monitoring individuals being treated with chloroquine (CQ) and/or hydroxychloroquine (HCQ) to align with FDA labeling.
  • Baseline examination within the first year of treatment and as an annual follow-up after five years of treatment. For higher-risk individuals, annual testing may begin immediately (without a 5-year delay).

In addition, the covered diagnosis codes for SCODI have been updated in the coding table to represent covered conditions.


Effective 10/05/2017 this policy has been updated to the new policy template format.


Version Effective Date: 09/10/2018
Version Issued Date: 09/10/2018
Version Reissued Date: N/A

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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.