Local Coverage Article Billing and Coding

Billing and Coding: Corneal Pachymetry

A56611

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Article ID
A56611
Article Title
Billing and Coding: Corneal Pachymetry
Article Type
Billing and Coding
Original Effective Date
06/06/2019
Revision Effective Date
05/12/2022
Revision Ending Date
N/A
Retirement Date
N/A
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

42 CFR §411.15(b)(2) and (c) addresses particular services excluded from coverage.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Corneal Pachymetry L34512.

Coding Information

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
76514 OPHTHALMIC ULTRASOUND, DIAGNOSTIC; CORNEAL PACHYMETRY, UNILATERAL OR BILATERAL (DETERMINATION OF CORNEAL THICKNESS)

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(211 Codes)
Group 1 Paragraph

The correct use of an ICD-10 code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the related LCD.

Group 1 Codes
CodeDescription
H18.11 Bullous keratopathy, right eye
H18.12 Bullous keratopathy, left eye
H18.13 Bullous keratopathy, bilateral
H18.461 Peripheral corneal degeneration, right eye
H18.462 Peripheral corneal degeneration, left eye
H18.463 Peripheral corneal degeneration, bilateral
H18.501 Unspecified hereditary corneal dystrophies, right eye
H18.502 Unspecified hereditary corneal dystrophies, left eye
H18.503 Unspecified hereditary corneal dystrophies, bilateral
H18.511 Endothelial corneal dystrophy, right eye
H18.512 Endothelial corneal dystrophy, left eye
H18.513 Endothelial corneal dystrophy, bilateral
H18.521 Epithelial (juvenile) corneal dystrophy, right eye
H18.522 Epithelial (juvenile) corneal dystrophy, left eye
H18.523 Epithelial (juvenile) corneal dystrophy, bilateral
H18.531 Granular corneal dystrophy, right eye
H18.532 Granular corneal dystrophy, left eye
H18.533 Granular corneal dystrophy, bilateral
H18.541 Lattice corneal dystrophy, right eye
H18.542 Lattice corneal dystrophy, left eye
H18.543 Lattice corneal dystrophy, bilateral
H18.551 Macular corneal dystrophy, right eye
H18.552 Macular corneal dystrophy, left eye
H18.553 Macular corneal dystrophy, bilateral
H18.591 Other hereditary corneal dystrophies, right eye
H18.592 Other hereditary corneal dystrophies, left eye
H18.593 Other hereditary corneal dystrophies, bilateral
H18.601 Keratoconus, unspecified, right eye
H18.602 Keratoconus, unspecified, left eye
H18.603 Keratoconus, unspecified, bilateral
H18.611 Keratoconus, stable, right eye
H18.612 Keratoconus, stable, left eye
H18.613 Keratoconus, stable, bilateral
H18.621 Keratoconus, unstable, right eye
H18.622 Keratoconus, unstable, left eye
H18.623 Keratoconus, unstable, bilateral
H21.551 Recession of chamber angle, right eye
H21.552 Recession of chamber angle, left eye
H21.553 Recession of chamber angle, bilateral
H40.001 Preglaucoma, unspecified, right eye
H40.002 Preglaucoma, unspecified, left eye
H40.003 Preglaucoma, unspecified, bilateral
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
H40.021 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
H40.031 Anatomical narrow angle, right eye
H40.032 Anatomical narrow angle, left eye
H40.033 Anatomical narrow angle, bilateral
H40.051 Ocular hypertension, right eye
H40.052 Ocular hypertension, left eye
H40.053 Ocular hypertension, bilateral
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
H40.1111 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
H40.1211 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
H40.1311 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
H40.151 Residual stage of open-angle glaucoma, right eye
H40.152 Residual stage of open-angle glaucoma, left eye
H40.153 Residual stage of open-angle glaucoma, bilateral
H40.211 Acute angle-closure glaucoma, right eye
H40.212 Acute angle-closure glaucoma, left eye
H40.213 Acute angle-closure glaucoma, bilateral
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
H40.241 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
H40.31X1 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
H40.51X1 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
H40.53X0 Glaucoma secondary to other eye disorders, bilateral, stage unspecified
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
H40.61X0 Glaucoma secondary to drugs, right eye, stage unspecified
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
H40.62X0 Glaucoma secondary to drugs, left eye, stage unspecified
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
H40.63X0 Glaucoma secondary to drugs, bilateral, stage unspecified
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
H40.821 Hypersecretion glaucoma, right eye
H40.822 Hypersecretion glaucoma, left eye
H40.823 Hypersecretion glaucoma, bilateral
H40.831 Aqueous misdirection, right eye
H40.832 Aqueous misdirection, left eye
H40.833 Aqueous misdirection, bilateral
H40.89 Other specified glaucoma
Q15.0 Congenital glaucoma
T85.318A Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, initial encounter
T85.318D Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, subsequent encounter
T85.318S Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, sequela
T85.328A Displacement of other ocular prosthetic devices, implants and grafts, initial encounter
T85.328D Displacement of other ocular prosthetic devices, implants and grafts, subsequent encounter
T85.328S Displacement of other ocular prosthetic devices, implants and grafts, sequela
T86.8401 Corneal transplant rejection, right eye
T86.8402 Corneal transplant rejection, left eye
T86.8403 Corneal transplant rejection, bilateral
T86.8411 Corneal transplant failure, right eye
T86.8412 Corneal transplant failure, left eye
T86.8413 Corneal transplant failure, bilateral
T86.8421 Corneal transplant infection, right eye
T86.8422 Corneal transplant infection, left eye
T86.8423 Corneal transplant infection, bilateral
T86.8481 Other complications of corneal transplant, right eye
T86.8482 Other complications of corneal transplant, left eye
T86.8483 Other complications of corneal transplant, bilateral
Z94.7 Corneal transplant status

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
05/12/2022 R5

Under CMS National Coverage Policy updated regulation from 42 CFR §411.15(b)(2)(c) to 42 CFR §411.15 (b)(2) and (c).

08/12/2021 R4

Under CMS National Coverage Policy added description for regulation Title XVIII of the Social Security Act, §1833(e). Formatting, punctuation and typographical errors were corrected throughout the article.

10/01/2020 R3

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted H40.041, H40.042, H40.043, H40.10X1, H40.10X2, H40.10X3, H40.10X4, H40.1110, H40.1120, H40.1130, H40.1210, H40.1220, H40.1230, H40.1310, H40.1320, H40.1330, H40.20X0, H40.20X1, H40.20X2, H40.20X3, H40.20X4, H40.2210, H40.2220, H40.2230, H40.31X0, H40.32X0, H40.33X0, H40.42X0, H40.43X0, H40.51X0, and H40.52X0. This revision will become effective 10/1/20.

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted H18.51, H18.59, T86.840, and T86.841, and added H18.501, H18.502, H18.503, H18.511, H18.512, H18.513, H18.521, H18.522, H18.523, H18.531, H18.532, H18.533, H18.541, H18.542, H18.543, H18.551, H18.552, H18.553, H18.591, H18.592, H18.593, T86.8401, T86.8402, T86.8403, T86.8411, T86.8412, T86.8413, T86.8421, T86.8422, T86.8423, T86.8481, T86.8482, and T86.8483. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.

10/10/2019 R2

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Corneal Pachymetry L34512 LCD and placed in this article.

 

06/06/2019 R1

All coding located in the Coding Information section has been removed from the related Corneal Pachymetry L34512 LCD and added to this article.

Associated Documents

Related Local Coverage Documents
LCDs
L34512 - Corneal Pachymetry
Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
05/02/2022 05/12/2022 - N/A Currently in Effect You are here
08/02/2021 08/12/2021 - 05/11/2022 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Corneal Pachymetry