SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Ocular Photography - External

A57068

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Contractor Information

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General Information

Source Article ID
N/A
Article ID
A57068
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Ocular Photography - External
Article Type
Billing and Coding
Original Effective Date
09/19/2019
Revision Effective Date
04/27/2023
Revision Ending Date
11/21/2023
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Language quoted from Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Code of Federal Regulations:

42 CFR Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements).

Article Guidance

Article Text

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L34393-Ocular Photography - External.

 

General Guidelines for Claims submitted to Part A or Part B MAC:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

 

Advance Beneficiary Notice of Non-coverage (ABN) Modifier Guidelines

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

The –GA modifier (“Waiver of Liability Statement Issued as Required by Payer Policy”) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions, sections 1862(a)(1), 1862(a)(9), 1879(e), or 1879(g) of the Social Security Act. Effective April 1, 2010, Part A MAC systems will automatically deny services billed with modifier GA. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN is required.

 

Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.

 

The –GZ modifier should be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an ABN signed by the beneficiary. ‎If the service is statutorily non-covered, or without a benefit category, submit the ‎appropriate CPT/HCPCS code with the -GY modifier. An ABN is not required for these denials, and the limitation of liability does not apply for beneficiaries. Services with modifier GY will automatically deny.

Documentation Requirements

The patient’s medical record should include but is not limited to:

  • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
  • Relevant medical history
  • Results of pertinent tests/procedures
  • Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. Office records/progress notes must document the complaint, symptomatology, or reason necessitating the test and must include the examination results/findings.

External ocular photographs may be print, slide, video or digital media, and copies must be available for review by Medicare if requested. Photographs must be permanently labeled with the patient’s name and date, and a notation of which eye is pictured. In addition to the photograph(s), an interpretation and report specific to the photograph(s) must be maintained in the patient's medical record and be available to the contractor upon request.

If additional photographs are taken to track changes in the patient’s condition, written documentation describing changes is required and must be maintained in the patient’s medical record. An interpretation of the photograph(s) with comparison to prior photographs, if available, must be maintained in the patient’s medical record and available for review, if requested.

The frequency with which external ocular photography should be performed is based on the patient's underlying condition and the usual progression of that condition. This service should not be repeated if there has been no change in the patient’s conditions.

In some cases, it is expected that this service would be reasonable once yearly. However, in certain conditions, this test may be appropriate more frequently.

For claims submitted to the Part B MAC:

Claims for external ocular photography services are payable under Medicare Part B in the following places of service.

The global service is payable in office (11), home (12), assisted living facility (13), temporary lodging (16), urgent care facility (20), nursing facility for patients not in a Part A stay (32), custodial care facility (33), and independent clinic (49).

Modifier TC is reported for the technical component of the service. The technical component is payable in office (11), home (12), assisted living facility (13), temporary lodging (16), urgent care facility (20), nursing facility for patients not in a Part A stay (32), custodial care facility (33), and independent clinic (49), federally qualified health center (50), and rural health clinic (72).

The professional component is reported with modifier 26 and is payable in office (11), home (12, assisted living facility (13), temporary lodging (16), urgent care facility (20), inpatient hospital (21), outpatient hospital (22), emergency room (23), skilled nursing facility for patients in a Part A stay (31), nursing facility for patients not in a Part A stay (32), custodial care facility (33), and independent clinic (49).

For claims submitted to the Part A MAC:

Hospital Inpatient Claims:

  • The hospital should report the patient's principal diagnosis in Form Locator (FL) 67 of the UB-04. The principal diagnosis is the condition established after study to be chiefly responsible for this admission.
  • The hospital enters ICD-10-CM codes for up to eight additional conditions in FLs 67A-67Q if they co-existed at the time of admission or developed subsequently, and which had an effect upon the treatment or the length of stay. It may not duplicate the principal diagnosis listed in FL 67.
  • For inpatient hospital claims, the admitting diagnosis is required and should be recorded in FL 69. (See CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 25, Section 75 for additional instructions.)

Hospital Outpatient Claims:

  • The hospital should report the full ICD-10-CM code for the diagnosis shown to be chiefly responsible for the outpatient services in FL 67. If no definitive diagnosis is made during the outpatient evaluation, the patient’s symptom is reported. If the patient arrives without a referring diagnosis, symptom or complaint, the provider should report an ICD-10-CM code for Persons Without Reported Diagnosis Encountered During Examination and Investigation of Individuals and Populations (Z00.00-Z13.9).
  • The hospital enters the full ICD-10-CM codes in FLs 67A-67Q for up to eight other diagnoses that co-existed in addition to the diagnosis reported in FL 67.

For dates of service prior to April 1, 2010, FQHC services should be reported with bill type 73X. For dates of service on or after April 1, 2010, bill type 77X should be used to report FQHC services.Bill type codes only apply to providers who bill these services to the Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

For dates of service on or after April 1, 2010, bill type 77X should be used to report FQHC services.

For outpatient settings other than CORFs, references to "physicians" throughout this policy include non-physicians, such as nurse practitioners, clinical nurse specialists and physician assistants. Such non-physician practitioners, with certain exceptions, may certify, order and establish the plan of care for external ocular photography services as authorized by State law. (See Sections 1861[s][2] and 1862[a][14] of Title XVIII of the Social Security Act; 42 CFR, Sections 410.74, 410.75, 410.76 and 419.22; 58 FR 18543, April 7, 2000.)

 Other Comments:

For claims submitted to the Part A MAC. This coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated CGS Administrators, LLC to process their claims.


Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes. 

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
071x Clinic - Rural Health
073x Clinic - Freestanding
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
N/A

Revenue Codes

Code Description
0510 Clinic - General Classification
0519 Clinic - Other Clinic
0520 Freestanding Clinic - General Classification
0761 Specialty Services - Treatment Room
0920 Other Diagnostic Services - General Classification
0929 Other Diagnostic Services - Other Diagnostic Service
0960 Professional Fees - General Classification
0982 Professional Fees - Outpatient Services
0983 Professional Fees - Clinic
N/A

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
92285 EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION AND REPORT FOR DOCUMENTATION OF MEDICAL PROGRESS (EG, CLOSE-UP PHOTOGRAPHY, SLIT LAMP PHOTOGRAPHY, GONIOPHOTOGRAPHY, STEREO-PHOTOGRAPHY)
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(1,032 Codes)
Group 1 Paragraph

It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code 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 this determination.

Group 1 Codes
Code Description
A18.51 Tuberculous episcleritis
A18.52 Tuberculous keratitis
A18.54 Tuberculous iridocyclitis
A18.59 Other tuberculosis of eye
A50.31 Late congenital syphilitic interstitial keratitis
B00.50 Herpesviral ocular disease, unspecified
B00.51 Herpesviral iridocyclitis
B00.52 Herpesviral keratitis
B00.53 Herpesviral conjunctivitis
B00.59 Other herpesviral disease of eye
B02.31 Zoster conjunctivitis
B02.32 Zoster iridocyclitis
B02.33 Zoster keratitis
B02.34 Zoster scleritis
B02.39 Other herpes zoster eye disease
B10.81 Human herpesvirus 6 infection
B10.82 Human herpesvirus 7 infection
B10.89 Other human herpesvirus infection
B30.0 Keratoconjunctivitis due to adenovirus
B60.12 Conjunctivitis due to Acanthamoeba
B60.13 Keratoconjunctivitis due to Acanthamoeba
C43.111 Malignant melanoma of right upper eyelid, including canthus
C43.112 Malignant melanoma of right lower eyelid, including canthus
C43.121 Malignant melanoma of left upper eyelid, including canthus
C43.122 Malignant melanoma of left lower eyelid, including canthus
C43.30 Malignant melanoma of unspecified part of face
C43.31 Malignant melanoma of nose
C43.39 Malignant melanoma of other parts of face
C44.1121 Basal cell carcinoma of skin of right upper eyelid, including canthus
C44.1122 Basal cell carcinoma of skin of right lower eyelid, including canthus
C44.1191 Basal cell carcinoma of skin of left upper eyelid, including canthus
C44.1192 Basal cell carcinoma of skin of left lower eyelid, including canthus
C44.1221 Squamous cell carcinoma of skin of right upper eyelid, including canthus
C44.1222 Squamous cell carcinoma of skin of right lower eyelid, including canthus
C44.1291 Squamous cell carcinoma of skin of left upper eyelid, including canthus
C44.1292 Squamous cell carcinoma of skin of left lower eyelid, including canthus
C44.1921 Other specified malignant neoplasm of skin of right upper eyelid, including canthus
C44.1922 Other specified malignant neoplasm of skin of right lower eyelid, including canthus
C44.1991 Other specified malignant neoplasm of skin of left upper eyelid, including canthus
C44.1992 Other specified malignant neoplasm of skin of left lower eyelid, including canthus
C47.0 Malignant neoplasm of peripheral nerves of head, face and neck
C49.0 Malignant neoplasm of connective and soft tissue of head, face and neck
C69.01 Malignant neoplasm of right conjunctiva
C69.02 Malignant neoplasm of left conjunctiva
C69.11 Malignant neoplasm of right cornea
C69.12 Malignant neoplasm of left cornea
C69.41 Malignant neoplasm of right ciliary body
C69.42 Malignant neoplasm of left ciliary body
C69.51 Malignant neoplasm of right lacrimal gland and duct
C69.52 Malignant neoplasm of left lacrimal gland and duct
C69.61 Malignant neoplasm of right orbit
C69.62 Malignant neoplasm of left orbit
C69.81 Malignant neoplasm of overlapping sites of right eye and adnexa
C69.82 Malignant neoplasm of overlapping sites of left eye and adnexa
C69.91 Malignant neoplasm of unspecified site of right eye
C69.92 Malignant neoplasm of unspecified site of left eye
D03.111 Melanoma in situ of right upper eyelid, including canthus
D03.112 Melanoma in situ of right lower eyelid, including canthus
D03.121 Melanoma in situ of left upper eyelid, including canthus
D03.122 Melanoma in situ of left lower eyelid, including canthus
D03.30 Melanoma in situ of unspecified part of face
D03.39 Melanoma in situ of other parts of face
D04.111 Carcinoma in situ of skin of right upper eyelid, including canthus
D04.112 Carcinoma in situ of skin of right lower eyelid, including canthus
D04.121 Carcinoma in situ of skin of left upper eyelid, including canthus
D04.122 Carcinoma in situ of skin of left lower eyelid, including canthus
D09.21 Carcinoma in situ of right eye
D09.22 Carcinoma in situ of left eye
D22.111 Melanocytic nevi of right upper eyelid, including canthus
D22.112 Melanocytic nevi of right lower eyelid, including canthus
D22.121 Melanocytic nevi of left upper eyelid, including canthus
D22.122 Melanocytic nevi of left lower eyelid, including canthus
D22.30 Melanocytic nevi of unspecified part of face
D22.39 Melanocytic nevi of other parts of face
D23.111 Other benign neoplasm of skin of right upper eyelid, including canthus
D23.112 Other benign neoplasm of skin of right lower eyelid, including canthus
D23.121 Other benign neoplasm of skin of left upper eyelid, including canthus
D23.122 Other benign neoplasm of skin of left lower eyelid, including canthus
D23.30 Other benign neoplasm of skin of unspecified part of face
D23.39 Other benign neoplasm of skin of other parts of face
D31.01 Benign neoplasm of right conjunctiva
D31.02 Benign neoplasm of left conjunctiva
D31.11 Benign neoplasm of right cornea
D31.12 Benign neoplasm of left cornea
D31.41 Benign neoplasm of right ciliary body
D31.42 Benign neoplasm of left ciliary body
D31.51 Benign neoplasm of right lacrimal gland and duct
D31.52 Benign neoplasm of left lacrimal gland and duct
D31.61 Benign neoplasm of unspecified site of right orbit
D31.62 Benign neoplasm of unspecified site of left orbit
D31.91 Benign neoplasm of unspecified part of right eye
D31.92 Benign neoplasm of unspecified part of left eye
D48.7 Neoplasm of uncertain behavior of other specified sites
H00.011 Hordeolum externum right upper eyelid
H00.012 Hordeolum externum right lower eyelid
H00.014 Hordeolum externum left upper eyelid
H00.015 Hordeolum externum left lower eyelid
H00.021 Hordeolum internum right upper eyelid
H00.022 Hordeolum internum right lower eyelid
H00.024 Hordeolum internum left upper eyelid
H00.025 Hordeolum internum left lower eyelid
H00.031 Abscess of right upper eyelid
H00.032 Abscess of right lower eyelid
H00.034 Abscess of left upper eyelid
H00.035 Abscess of left lower eyelid
H00.11 Chalazion right upper eyelid
H00.12 Chalazion right lower eyelid
H00.14 Chalazion left upper eyelid
H00.15 Chalazion left lower eyelid
H01.001 Unspecified blepharitis right upper eyelid
H01.002 Unspecified blepharitis right lower eyelid
H01.004 Unspecified blepharitis left upper eyelid
H01.005 Unspecified blepharitis left lower eyelid
H01.00A Unspecified blepharitis right eye, upper and lower eyelids
H01.00B Unspecified blepharitis left eye, upper and lower eyelids
H01.011 Ulcerative blepharitis right upper eyelid
H01.012 Ulcerative blepharitis right lower eyelid
H01.014 Ulcerative blepharitis left upper eyelid
H01.015 Ulcerative blepharitis left lower eyelid
H01.01A Ulcerative blepharitis right eye, upper and lower eyelids
H01.01B Ulcerative blepharitis left eye, upper and lower eyelids
H01.021 Squamous blepharitis right upper eyelid
H01.022 Squamous blepharitis right lower eyelid
H01.024 Squamous blepharitis left upper eyelid
H01.025 Squamous blepharitis left lower eyelid
H01.02A Squamous blepharitis right eye, upper and lower eyelids
H01.02B Squamous blepharitis left eye, upper and lower eyelids
H01.111 Allergic dermatitis of right upper eyelid
H01.112 Allergic dermatitis of right lower eyelid
H01.114 Allergic dermatitis of left upper eyelid
H01.115 Allergic dermatitis of left lower eyelid
H01.121 Discoid lupus erythematosus of right upper eyelid
H01.122 Discoid lupus erythematosus of right lower eyelid
H01.124 Discoid lupus erythematosus of left upper eyelid
H01.125 Discoid lupus erythematosus of left lower eyelid
H01.131 Eczematous dermatitis of right upper eyelid
H01.132 Eczematous dermatitis of right lower eyelid
H01.134 Eczematous dermatitis of left upper eyelid
H01.135 Eczematous dermatitis of left lower eyelid
H01.141 Xeroderma of right upper eyelid
H01.142 Xeroderma of right lower eyelid
H01.144 Xeroderma of left upper eyelid
H01.145 Xeroderma of left lower eyelid
H01.8 Other specified inflammations of eyelid
H01.9 Unspecified inflammation of eyelid
H02.001 Unspecified entropion of right upper eyelid
H02.002 Unspecified entropion of right lower eyelid
H02.004 Unspecified entropion of left upper eyelid
H02.005 Unspecified entropion of left lower eyelid
H02.011 Cicatricial entropion of right upper eyelid
H02.012 Cicatricial entropion of right lower eyelid
H02.014 Cicatricial entropion of left upper eyelid
H02.015 Cicatricial entropion of left lower eyelid
H02.021 Mechanical entropion of right upper eyelid
H02.022 Mechanical entropion of right lower eyelid
H02.024 Mechanical entropion of left upper eyelid
H02.025 Mechanical entropion of left lower eyelid
H02.031 Senile entropion of right upper eyelid
H02.032 Senile entropion of right lower eyelid
H02.034 Senile entropion of left upper eyelid
H02.035 Senile entropion of left lower eyelid
H02.041 Spastic entropion of right upper eyelid
H02.042 Spastic entropion of right lower eyelid
H02.044 Spastic entropion of left upper eyelid
H02.045 Spastic entropion of left lower eyelid
H02.051 Trichiasis without entropion right upper eyelid
H02.052 Trichiasis without entropion right lower eyelid
H02.054 Trichiasis without entropion left upper eyelid
H02.055 Trichiasis without entropion left lower eyelid
H02.101 Unspecified ectropion of right upper eyelid
H02.102 Unspecified ectropion of right lower eyelid
H02.104 Unspecified ectropion of left upper eyelid
H02.105 Unspecified ectropion of left lower eyelid
H02.111 Cicatricial ectropion of right upper eyelid
H02.112 Cicatricial ectropion of right lower eyelid
H02.114 Cicatricial ectropion of left upper eyelid
H02.115 Cicatricial ectropion of left lower eyelid
H02.121 Mechanical ectropion of right upper eyelid
H02.122 Mechanical ectropion of right lower eyelid
H02.124 Mechanical ectropion of left upper eyelid
H02.125 Mechanical ectropion of left lower eyelid
H02.131 Senile ectropion of right upper eyelid
H02.132 Senile ectropion of right lower eyelid
H02.134 Senile ectropion of left upper eyelid
H02.135 Senile ectropion of left lower eyelid
H02.141 Spastic ectropion of right upper eyelid
H02.142 Spastic ectropion of right lower eyelid
H02.144 Spastic ectropion of left upper eyelid
H02.145 Spastic ectropion of left lower eyelid
H02.151 Paralytic ectropion of right upper eyelid
H02.152 Paralytic ectropion of right lower eyelid
H02.153 Paralytic ectropion of right eye, unspecified eyelid
H02.154 Paralytic ectropion of left upper eyelid
H02.155 Paralytic ectropion of left lower eyelid
H02.156 Paralytic ectropion of left eye, unspecified eyelid
H02.521 Blepharophimosis right upper eyelid
H02.522 Blepharophimosis right lower eyelid
H02.524 Blepharophimosis left upper eyelid
H02.525 Blepharophimosis left lower eyelid
H02.61 Xanthelasma of right upper eyelid
H02.62 Xanthelasma of right lower eyelid
H02.64 Xanthelasma of left upper eyelid
H02.65 Xanthelasma of left lower eyelid
H02.70 Unspecified degenerative disorders of eyelid and periocular area
H02.711 Chloasma of right upper eyelid and periocular area
H02.712 Chloasma of right lower eyelid and periocular area
H02.714 Chloasma of left upper eyelid and periocular area
H02.715 Chloasma of left lower eyelid and periocular area
H02.721 Madarosis of right upper eyelid and periocular area
H02.722 Madarosis of right lower eyelid and periocular area
H02.724 Madarosis of left upper eyelid and periocular area
H02.725 Madarosis of left lower eyelid and periocular area
H02.731 Vitiligo of right upper eyelid and periocular area
H02.732 Vitiligo of right lower eyelid and periocular area
H02.734 Vitiligo of left upper eyelid and periocular area
H02.735 Vitiligo of left lower eyelid and periocular area
H02.79 Other degenerative disorders of eyelid and periocular area
H02.811 Retained foreign body in right upper eyelid
H02.812 Retained foreign body in right lower eyelid
H02.814 Retained foreign body in left upper eyelid
H02.815 Retained foreign body in left lower eyelid
H02.821 Cysts of right upper eyelid
H02.822 Cysts of right lower eyelid
H02.824 Cysts of left upper eyelid
H02.825 Cysts of left lower eyelid
H02.841 Edema of right upper eyelid
H02.842 Edema of right lower eyelid
H02.844 Edema of left upper eyelid
H02.845 Edema of left lower eyelid
H02.851 Elephantiasis of right upper eyelid
H02.852 Elephantiasis of right lower eyelid
H02.854 Elephantiasis of left upper eyelid
H02.855 Elephantiasis of left lower eyelid
H02.861 Hypertrichosis of right upper eyelid
H02.862 Hypertrichosis of right lower eyelid
H02.864 Hypertrichosis of left upper eyelid
H02.865 Hypertrichosis of left lower eyelid
H02.871 Vascular anomalies of right upper eyelid
H02.872 Vascular anomalies of right lower eyelid
H02.874 Vascular anomalies of left upper eyelid
H02.875 Vascular anomalies of left lower eyelid
H02.881 Meibomian gland dysfunction right upper eyelid
H02.882 Meibomian gland dysfunction right lower eyelid
H02.884 Meibomian gland dysfunction left upper eyelid
H02.885 Meibomian gland dysfunction left lower eyelid
H02.88A Meibomian gland dysfunction right eye, upper and lower eyelids
H02.88B Meibomian gland dysfunction left eye, upper and lower eyelids
H02.89 Other specified disorders of eyelid
H02.9 Unspecified disorder of eyelid
H04.001 Unspecified dacryoadenitis, right lacrimal gland
H04.002 Unspecified dacryoadenitis, left lacrimal gland
H04.003 Unspecified dacryoadenitis, bilateral lacrimal glands
H04.011 Acute dacryoadenitis, right lacrimal gland
H04.012 Acute dacryoadenitis, left lacrimal gland
H04.013 Acute dacryoadenitis, bilateral lacrimal glands
H04.021 Chronic dacryoadenitis, right lacrimal gland
H04.022 Chronic dacryoadenitis, left lacrimal gland
H04.023 Chronic dacryoadenitis, bilateral lacrimal gland
H04.031 Chronic enlargement of right lacrimal gland
H04.032 Chronic enlargement of left lacrimal gland
H04.033 Chronic enlargement of bilateral lacrimal glands
H04.111 Dacryops of right lacrimal gland
H04.112 Dacryops of left lacrimal gland
H04.113 Dacryops of bilateral lacrimal glands
H04.121 Dry eye syndrome of right lacrimal gland
H04.122 Dry eye syndrome of left lacrimal gland
H04.123 Dry eye syndrome of bilateral lacrimal glands
H04.131 Lacrimal cyst, right lacrimal gland
H04.132 Lacrimal cyst, left lacrimal gland
H04.133 Lacrimal cyst, bilateral lacrimal glands
H04.141 Primary lacrimal gland atrophy, right lacrimal gland
H04.142 Primary lacrimal gland atrophy, left lacrimal gland
H04.143 Primary lacrimal gland atrophy, bilateral lacrimal glands
H04.151 Secondary lacrimal gland atrophy, right lacrimal gland
H04.152 Secondary lacrimal gland atrophy, left lacrimal gland
H04.153 Secondary lacrimal gland atrophy, bilateral lacrimal glands
H04.161 Lacrimal gland dislocation, right lacrimal gland
H04.162 Lacrimal gland dislocation, left lacrimal gland
H04.163 Lacrimal gland dislocation, bilateral lacrimal glands
H04.19 Other specified disorders of lacrimal gland
H04.301 Unspecified dacryocystitis of right lacrimal passage
H04.302 Unspecified dacryocystitis of left lacrimal passage
H04.303 Unspecified dacryocystitis of bilateral lacrimal passages
H04.311 Phlegmonous dacryocystitis of right lacrimal passage
H04.312 Phlegmonous dacryocystitis of left lacrimal passage
H04.313 Phlegmonous dacryocystitis of bilateral lacrimal passages
H04.321 Acute dacryocystitis of right lacrimal passage
H04.322 Acute dacryocystitis of left lacrimal passage
H04.323 Acute dacryocystitis of bilateral lacrimal passages
H04.331 Acute lacrimal canaliculitis of right lacrimal passage
H04.332 Acute lacrimal canaliculitis of left lacrimal passage
H04.333 Acute lacrimal canaliculitis of bilateral lacrimal passages
H04.411 Chronic dacryocystitis of right lacrimal passage
H04.412 Chronic dacryocystitis of left lacrimal passage
H04.413 Chronic dacryocystitis of bilateral lacrimal passages
H04.421 Chronic lacrimal canaliculitis of right lacrimal passage
H04.422 Chronic lacrimal canaliculitis of left lacrimal passage
H04.423 Chronic lacrimal canaliculitis of bilateral lacrimal passages
H04.431 Chronic lacrimal mucocele of right lacrimal passage
H04.432 Chronic lacrimal mucocele of left lacrimal passage
H04.433 Chronic lacrimal mucocele of bilateral lacrimal passages
H04.511 Dacryolith of right lacrimal passage
H04.512 Dacryolith of left lacrimal passage
H04.513 Dacryolith of bilateral lacrimal passages
H04.521 Eversion of right lacrimal punctum
H04.522 Eversion of left lacrimal punctum
H04.523 Eversion of bilateral lacrimal punctum
H04.531 Neonatal obstruction of right nasolacrimal duct
H04.532 Neonatal obstruction of left nasolacrimal duct
H04.533 Neonatal obstruction of bilateral nasolacrimal duct
H04.541 Stenosis of right lacrimal canaliculi
H04.542 Stenosis of left lacrimal canaliculi
H04.543 Stenosis of bilateral lacrimal canaliculi
H04.551 Acquired stenosis of right nasolacrimal duct
H04.552 Acquired stenosis of left nasolacrimal duct
H04.553 Acquired stenosis of bilateral nasolacrimal duct
H04.561 Stenosis of right lacrimal punctum
H04.562 Stenosis of left lacrimal punctum
H04.563 Stenosis of bilateral lacrimal punctum
H04.571 Stenosis of right lacrimal sac
H04.572 Stenosis of left lacrimal sac
H04.573 Stenosis of bilateral lacrimal sac
H04.611 Lacrimal fistula right lacrimal passage
H04.612 Lacrimal fistula left lacrimal passage
H04.613 Lacrimal fistula bilateral lacrimal passages
H04.69 Other changes of lacrimal passages
H04.811 Granuloma of right lacrimal passage
H04.812 Granuloma of left lacrimal passage
H04.813 Granuloma of bilateral lacrimal passages
H04.89 Other disorders of lacrimal system
H04.9 Disorder of lacrimal system, unspecified
H05.00 Unspecified acute inflammation of orbit
H05.011 Cellulitis of right orbit
H05.012 Cellulitis of left orbit
H05.013 Cellulitis of bilateral orbits
H05.021 Osteomyelitis of right orbit
H05.022 Osteomyelitis of left orbit
H05.023 Osteomyelitis of bilateral orbits
H05.031 Periostitis of right orbit
H05.032 Periostitis of left orbit
H05.033 Periostitis of bilateral orbits
H05.041 Tenonitis of right orbit
H05.042 Tenonitis of left orbit
H05.043 Tenonitis of bilateral orbits
H05.10 Unspecified chronic inflammatory disorders of orbit
H05.111 Granuloma of right orbit
H05.112 Granuloma of left orbit
H05.113 Granuloma of bilateral orbits
H05.121 Orbital myositis, right orbit
H05.122 Orbital myositis, left orbit
H05.123 Orbital myositis, bilateral
H05.20 Unspecified exophthalmos
H05.211 Displacement (lateral) of globe, right eye
H05.212 Displacement (lateral) of globe, left eye
H05.213 Displacement (lateral) of globe, bilateral
H05.221 Edema of right orbit
H05.222 Edema of left orbit
H05.223 Edema of bilateral orbit
H05.231 Hemorrhage of right orbit
H05.232 Hemorrhage of left orbit
H05.233 Hemorrhage of bilateral orbit
H05.241 Constant exophthalmos, right eye
H05.242 Constant exophthalmos, left eye
H05.243 Constant exophthalmos, bilateral
H05.251 Intermittent exophthalmos, right eye
H05.252 Intermittent exophthalmos, left eye
H05.253 Intermittent exophthalmos, bilateral
H05.261 Pulsating exophthalmos, right eye
H05.262 Pulsating exophthalmos, left eye
H05.263 Pulsating exophthalmos, bilateral
H05.30 Unspecified deformity of orbit
H05.311 Atrophy of right orbit
H05.312 Atrophy of left orbit
H05.313 Atrophy of bilateral orbit
H05.321 Deformity of right orbit due to bone disease
H05.322 Deformity of left orbit due to bone disease
H05.323 Deformity of bilateral orbits due to bone disease
H05.331 Deformity of right orbit due to trauma or surgery
H05.332 Deformity of left orbit due to trauma or surgery
H05.333 Deformity of bilateral orbits due to trauma or surgery
H05.341 Enlargement of right orbit
H05.342 Enlargement of left orbit
H05.343 Enlargement of bilateral orbits
H05.351 Exostosis of right orbit
H05.352 Exostosis of left orbit
H05.353 Exostosis of bilateral orbits
H05.401 Unspecified enophthalmos, right eye
H05.402 Unspecified enophthalmos, left eye
H05.403 Unspecified enophthalmos, bilateral
H05.411 Enophthalmos due to atrophy of orbital tissue, right eye
H05.412 Enophthalmos due to atrophy of orbital tissue, left eye
H05.413 Enophthalmos due to atrophy of orbital tissue, bilateral
H05.421 Enophthalmos due to trauma or surgery, right eye
H05.422 Enophthalmos due to trauma or surgery, left eye
H05.423 Enophthalmos due to trauma or surgery, bilateral
H05.51 Retained (old) foreign body following penetrating wound of right orbit
H05.52 Retained (old) foreign body following penetrating wound of left orbit
H05.53 Retained (old) foreign body following penetrating wound of bilateral orbits
H05.811 Cyst of right orbit
H05.812 Cyst of left orbit
H05.813 Cyst of bilateral orbits
H05.821 Myopathy of extraocular muscles, right orbit
H05.822 Myopathy of extraocular muscles, left orbit
H05.823 Myopathy of extraocular muscles, bilateral
H05.89 Other disorders of orbit
H05.9 Unspecified disorder of orbit
H10.011 - H10.013 Acute follicular conjunctivitis, right eye - Acute follicular conjunctivitis, bilateral
H10.021 - H10.023 Other mucopurulent conjunctivitis, right eye - Other mucopurulent conjunctivitis, bilateral
H10.11 - H10.13 Acute atopic conjunctivitis, right eye - Acute atopic conjunctivitis, bilateral
H10.211 - H10.213 Acute toxic conjunctivitis, right eye - Acute toxic conjunctivitis, bilateral
H10.221 - H10.223 Pseudomembranous conjunctivitis, right eye - Pseudomembranous conjunctivitis, bilateral
H10.231 - H10.233 Serous conjunctivitis, except viral, right eye - Serous conjunctivitis, except viral, bilateral
H10.31 - H10.33 Unspecified acute conjunctivitis, right eye - Unspecified acute conjunctivitis, bilateral
H10.401 - H10.403 Unspecified chronic conjunctivitis, right eye - Unspecified chronic conjunctivitis, bilateral
H10.411 - H10.413 Chronic giant papillary conjunctivitis, right eye - Chronic giant papillary conjunctivitis, bilateral
H10.421 - H10.423 Simple chronic conjunctivitis, right eye - Simple chronic conjunctivitis, bilateral
H10.431 - H10.433 Chronic follicular conjunctivitis, right eye - Chronic follicular conjunctivitis, bilateral
H10.44 Vernal conjunctivitis
H10.45 Other chronic allergic conjunctivitis
H10.501 - H10.503 Unspecified blepharoconjunctivitis, right eye - Unspecified blepharoconjunctivitis, bilateral
H10.511 - H10.513 Ligneous conjunctivitis, right eye - Ligneous conjunctivitis, bilateral
H10.521 - H10.523 Angular blepharoconjunctivitis, right eye - Angular blepharoconjunctivitis, bilateral
H10.531 - H10.533 Contact blepharoconjunctivitis, right eye - Contact blepharoconjunctivitis, bilateral
H10.821 Rosacea conjunctivitis, right eye
H10.822 Rosacea conjunctivitis, left eye
H10.823 Rosacea conjunctivitis, bilateral
H10.89 Other conjunctivitis
H10.9 Unspecified conjunctivitis
H11.001 - H11.003 Unspecified pterygium of right eye - Unspecified pterygium of eye, bilateral
H11.011 - H11.013 Amyloid pterygium of right eye - Amyloid pterygium of eye, bilateral
H11.021 - H11.023 Central pterygium of right eye - Central pterygium of eye, bilateral
H11.031 - H11.033 Double pterygium of right eye - Double pterygium of eye, bilateral
H11.041 - H11.043 Peripheral pterygium, stationary, right eye - Peripheral pterygium, stationary, bilateral
H11.051 - H11.053 Peripheral pterygium, progressive, right eye - Peripheral pterygium, progressive, bilateral
H11.061 - H11.063 Recurrent pterygium of right eye - Recurrent pterygium of eye, bilateral
H11.10 Unspecified conjunctival degenerations
H11.111 - H11.113 Conjunctival deposits, right eye - Conjunctival deposits, bilateral
H11.121 - H11.123 Conjunctival concretions, right eye - Conjunctival concretions, bilateral
H11.131 - H11.133 Conjunctival pigmentations, right eye - Conjunctival pigmentations, bilateral
H11.141 - H11.143 Conjunctival xerosis, unspecified, right eye - Conjunctival xerosis, unspecified, bilateral
H11.151 - H11.153 Pinguecula, right eye - Pinguecula, bilateral
H11.211 - H11.213 Conjunctival adhesions and strands (localized), right eye - Conjunctival adhesions and strands (localized), bilateral
H11.221 - H11.223 Conjunctival granuloma, right eye - Conjunctival granuloma, bilateral
H11.231 - H11.233 Symblepharon, right eye - Symblepharon, bilateral
H11.241 - H11.243 Scarring of conjunctiva, right eye - Scarring of conjunctiva, bilateral
H11.31 - H11.33 Conjunctival hemorrhage, right eye - Conjunctival hemorrhage, bilateral
H11.411 - H11.413 Vascular abnormalities of conjunctiva, right eye - Vascular abnormalities of conjunctiva, bilateral
H11.421 - H11.423 Conjunctival edema, right eye - Conjunctival edema, bilateral
H11.431 - H11.433 Conjunctival hyperemia, right eye - Conjunctival hyperemia, bilateral
H11.441 - H11.443 Conjunctival cysts, right eye - Conjunctival cysts, bilateral
H11.811 - H11.813 Pseudopterygium of conjunctiva, right eye - Pseudopterygium of conjunctiva, bilateral
H11.821 - H11.823 Conjunctivochalasis, right eye - Conjunctivochalasis, bilateral
H11.89 Other specified disorders of conjunctiva
H11.9 Unspecified disorder of conjunctiva
H15.001 - H15.003 Unspecified scleritis, right eye - Unspecified scleritis, bilateral
H15.011 - H15.013 Anterior scleritis, right eye - Anterior scleritis, bilateral
H15.021 - H15.023 Brawny scleritis, right eye - Brawny scleritis, bilateral
H15.031 - H15.033 Posterior scleritis, right eye - Posterior scleritis, bilateral
H15.041 - H15.043 Scleritis with corneal involvement, right eye - Scleritis with corneal involvement, bilateral
H15.051 - H15.053 Scleromalacia perforans, right eye - Scleromalacia perforans, bilateral
H15.091 - H15.093 Other scleritis, right eye - Other scleritis, bilateral
H15.101 - H15.103 Unspecified episcleritis, right eye - Unspecified episcleritis, bilateral
H15.111 - H15.113 Episcleritis periodica fugax, right eye - Episcleritis periodica fugax, bilateral
H15.121 - H15.123 Nodular episcleritis, right eye - Nodular episcleritis, bilateral
H15.811 - H15.813 Equatorial staphyloma, right eye - Equatorial staphyloma, bilateral
H15.821 - H15.823 Localized anterior staphyloma, right eye - Localized anterior staphyloma, bilateral
H15.841 - H15.843 Scleral ectasia, right eye - Scleral ectasia, bilateral
H15.851 - H15.853 Ring staphyloma, right eye - Ring staphyloma, bilateral
H16.001 - H16.003 Unspecified corneal ulcer, right eye - Unspecified corneal ulcer, bilateral
H16.011 - H16.013 Central corneal ulcer, right eye - Central corneal ulcer, bilateral
H16.021 - H16.023 Ring corneal ulcer, right eye - Ring corneal ulcer, bilateral
H16.031 - H16.033 Corneal ulcer with hypopyon, right eye - Corneal ulcer with hypopyon, bilateral
H16.041 - H16.043 Marginal corneal ulcer, right eye - Marginal corneal ulcer, bilateral
H16.051 - H16.053 Mooren's corneal ulcer, right eye - Mooren's corneal ulcer, bilateral
H16.061 - H16.063 Mycotic corneal ulcer, right eye - Mycotic corneal ulcer, bilateral
H16.071 - H16.073 Perforated corneal ulcer, right eye - Perforated corneal ulcer, bilateral
H16.101 - H16.103 Unspecified superficial keratitis, right eye - Unspecified superficial keratitis, bilateral
H16.111 - H16.113 Macular keratitis, right eye - Macular keratitis, bilateral
H16.121 - H16.123 Filamentary keratitis, right eye - Filamentary keratitis, bilateral
H16.131 - H16.133 Photokeratitis, right eye - Photokeratitis, bilateral
H16.141 - H16.143 Punctate keratitis, right eye - Punctate keratitis, bilateral
H16.211 - H16.213 Exposure keratoconjunctivitis, right eye - Exposure keratoconjunctivitis, bilateral
H16.221 - H16.223 Keratoconjunctivitis sicca, not specified as Sjogren's, right eye - Keratoconjunctivitis sicca, not specified as Sjogren's, bilateral
H16.231 - H16.233 Neurotrophic keratoconjunctivitis, right eye - Neurotrophic keratoconjunctivitis, bilateral
H16.241 - H16.243 Ophthalmia nodosa, right eye - Ophthalmia nodosa, bilateral
H16.251 - H16.253 Phlyctenular keratoconjunctivitis, right eye - Phlyctenular keratoconjunctivitis, bilateral
H16.261 - H16.263 Vernal keratoconjunctivitis, with limbar and corneal involvement, right eye - Vernal keratoconjunctivitis, with limbar and corneal involvement, bilateral
H16.301 - H16.303 Unspecified interstitial keratitis, right eye - Unspecified interstitial keratitis, bilateral
H16.311 - H16.313 Corneal abscess, right eye - Corneal abscess, bilateral
H16.321 - H16.323 Diffuse interstitial keratitis, right eye - Diffuse interstitial keratitis, bilateral
H16.331 - H16.333 Sclerosing keratitis, right eye - Sclerosing keratitis, bilateral
H16.401 - H16.403 Unspecified corneal neovascularization, right eye - Unspecified corneal neovascularization, bilateral
H16.411 - H16.413 Ghost vessels (corneal), right eye - Ghost vessels (corneal), bilateral
H16.421 - H16.423 Pannus (corneal), right eye - Pannus (corneal), bilateral
H16.431 - H16.433 Localized vascularization of cornea, right eye - Localized vascularization of cornea, bilateral
H16.441 - H16.443 Deep vascularization of cornea, right eye - Deep vascularization of cornea, bilateral
H16.8 Other keratitis
H16.9 Unspecified keratitis
H17.01 - H17.03 Adherent leukoma, right eye - Adherent leukoma, bilateral
H17.11 - H17.13 Central corneal opacity, right eye - Central corneal opacity, bilateral
H17.811 - H17.813 Minor opacity of cornea, right eye - Minor opacity of cornea, bilateral
H17.821 - H17.823 Peripheral opacity of cornea, right eye - Peripheral opacity of cornea, bilateral
H17.89 Other corneal scars and opacities
H17.9 Unspecified corneal scar and opacity
H18.001 - H18.003 Unspecified corneal deposit, right eye - Unspecified corneal deposit, bilateral
H18.011 - H18.013 Anterior corneal pigmentations, right eye - Anterior corneal pigmentations, bilateral
H18.021 - H18.023 Argentous corneal deposits, right eye - Argentous corneal deposits, bilateral
H18.031 - H18.033 Corneal deposits in metabolic disorders, right eye - Corneal deposits in metabolic disorders, bilateral
H18.041 - H18.043 Kayser-Fleischer ring, right eye - Kayser-Fleischer ring, bilateral
H18.051 - H18.053 Posterior corneal pigmentations, right eye - Posterior corneal pigmentations, bilateral
H18.061 - H18.063 Stromal corneal pigmentations, right eye - Stromal corneal pigmentations, bilateral
H18.11 - H18.13 Bullous keratopathy, right eye - Bullous keratopathy, bilateral
H18.20 Unspecified corneal edema
H18.211 - H18.213 Corneal edema secondary to contact lens, right eye - Corneal edema secondary to contact lens, bilateral
H18.221 - H18.223 Idiopathic corneal edema, right eye - Idiopathic corneal edema, bilateral
H18.231 - H18.233 Secondary corneal edema, right eye - Secondary corneal edema, bilateral
H18.30 Unspecified corneal membrane change
H18.311 - H18.313 Folds and rupture in Bowman's membrane, right eye - Folds and rupture in Bowman's membrane, bilateral
H18.321 - H18.323 Folds in Descemet's membrane, right eye - Folds in Descemet's membrane, bilateral
H18.331 - H18.333 Rupture in Descemet's membrane, right eye - Rupture in Descemet's membrane, bilateral
H18.40 Unspecified corneal degeneration
H18.411 - H18.413 Arcus senilis, right eye - Arcus senilis, bilateral
H18.421 - H18.423 Band keratopathy, right eye - Band keratopathy, bilateral
H18.43 Other calcerous corneal degeneration
H18.441 - H18.443 Keratomalacia, right eye - Keratomalacia, bilateral
H18.451 - H18.453 Nodular corneal degeneration, right eye - Nodular corneal degeneration, bilateral
H18.461 - H18.463 Peripheral corneal degeneration, right eye - Peripheral corneal degeneration, bilateral
H18.49 Other corneal degeneration
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 - H18.603 Keratoconus, unspecified, right eye - Keratoconus, unspecified, bilateral
H18.611 - H18.613 Keratoconus, stable, right eye - Keratoconus, stable, bilateral
H18.621 - H18.623 Keratoconus, unstable, right eye - Keratoconus, unstable, bilateral
H18.70 Unspecified corneal deformity
H18.711 - H18.713 Corneal ectasia, right eye - Corneal ectasia, bilateral
H18.721 - H18.723 Corneal staphyloma, right eye - Corneal staphyloma, bilateral
H18.731 - H18.733 Descemetocele, right eye - Descemetocele, bilateral
H18.791 - H18.793 Other corneal deformities, right eye - Other corneal deformities, bilateral
H18.831 - H18.833 Recurrent erosion of cornea, right eye - Recurrent erosion of cornea, bilateral
H18.9 Unspecified disorder of cornea
H20.00 Unspecified acute and subacute iridocyclitis
H20.011 - H20.013 Primary iridocyclitis, right eye - Primary iridocyclitis, bilateral
H20.021 - H20.023 Recurrent acute iridocyclitis, right eye - Recurrent acute iridocyclitis, bilateral
H20.031 - H20.033 Secondary infectious iridocyclitis, right eye - Secondary infectious iridocyclitis, bilateral
H20.041 - H20.043 Secondary noninfectious iridocyclitis, right eye - Secondary noninfectious iridocyclitis, bilateral
H20.051 - H20.053 Hypopyon, right eye - Hypopyon, bilateral
H20.11 - H20.13 Chronic iridocyclitis, right eye - Chronic iridocyclitis, bilateral
H20.21 - H20.23 Lens-induced iridocyclitis, right eye - Lens-induced iridocyclitis, bilateral
H20.811 - H20.813 Fuchs' heterochromic cyclitis, right eye - Fuchs' heterochromic cyclitis, bilateral
H20.821 - H20.823 Vogt-Koyanagi syndrome, right eye - Vogt-Koyanagi syndrome, bilateral
H20.9 Unspecified iridocyclitis
H21.01 - H21.03 Hyphema, right eye - Hyphema, bilateral
H21.1X1 Other vascular disorders of iris and ciliary body, right eye
H21.1X2 Other vascular disorders of iris and ciliary body, left eye
H21.1X3 Other vascular disorders of iris and ciliary body, bilateral
H21.211 - H21.213 Degeneration of chamber angle, right eye - Degeneration of chamber angle, bilateral
H21.221 - H21.223 Degeneration of ciliary body, right eye - Degeneration of ciliary body, bilateral
H21.231 - H21.233 Degeneration of iris (pigmentary), right eye - Degeneration of iris (pigmentary), bilateral
H21.241 - H21.243 Degeneration of pupillary margin, right eye - Degeneration of pupillary margin, bilateral
H21.251 - H21.253 Iridoschisis, right eye - Iridoschisis, bilateral
H21.261 - H21.263 Iris atrophy (essential) (progressive), right eye - Iris atrophy (essential) (progressive), bilateral
H21.271 - H21.273 Miotic pupillary cyst, right eye - Miotic pupillary cyst, bilateral
H21.29 Other iris atrophy
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
H21.311 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
H21.321 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
H21.331 Parasitic cyst of iris, ciliary body or anterior chamber, right eye
H21.332 Parasitic cyst of iris, ciliary body or anterior chamber, left eye
H21.333 Parasitic cyst of iris, ciliary body or anterior chamber, bilateral
H21.341 Primary cyst of pars plana, right eye
H21.342 Primary cyst of pars plana, left eye
H21.343 Primary cyst of pars plana, bilateral
H21.351 Exudative cyst of pars plana, right eye
H21.352 Exudative cyst of pars plana, left eye
H21.353 Exudative cyst of pars plana, bilateral
H21.41 Pupillary membranes, right eye
H21.42 Pupillary membranes, left eye
H21.43 Pupillary membranes, bilateral
H21.501 Unspecified adhesions of iris, right eye
H21.502 Unspecified adhesions of iris, left eye
H21.503 Unspecified adhesions of iris, bilateral
H21.511 Anterior synechiae (iris), right eye
H21.512 Anterior synechiae (iris), left eye
H21.513 Anterior synechiae (iris), bilateral
H21.521 Goniosynechiae, right eye
H21.522 Goniosynechiae, left eye
H21.523 Goniosynechiae, bilateral
H21.531 Iridodialysis, right eye
H21.532 Iridodialysis, left eye
H21.533 Iridodialysis, bilateral
H21.541 Posterior synechiae (iris), right eye
H21.542 Posterior synechiae (iris), left eye
H21.543 Posterior synechiae (iris), bilateral
H21.551 Recession of chamber angle, right eye
H21.552 Recession of chamber angle, left eye
H21.553 Recession of chamber angle, bilateral
H21.561 Pupillary abnormality, right eye
H21.562 Pupillary abnormality, left eye
H21.563 Pupillary abnormality, bilateral
H21.81 Floppy iris syndrome
H21.89 Other specified disorders of iris and ciliary body
H21.9 Unspecified disorder of iris and ciliary body
H22 Disorders of iris and ciliary body in diseases classified elsewhere
H25.89 Other age-related cataract
H27.01 Aphakia, right eye
H27.02 Aphakia, left eye
H27.03 Aphakia, bilateral
H27.111 Subluxation of lens, right eye
H27.112 Subluxation of lens, left eye
H27.113 Subluxation of lens, bilateral
H27.121 Anterior dislocation of lens, right eye
H27.122 Anterior dislocation of lens, left eye
H27.123 Anterior dislocation of lens, bilateral
H27.131 Posterior dislocation of lens, right eye
H27.132 Posterior dislocation of lens, left eye
H27.133 Posterior dislocation of lens, bilateral
H27.8 Other specified disorders of lens
H27.9 Unspecified disorder of lens
H33.121 Parasitic cyst of retina, right eye
H33.122 Parasitic cyst of retina, left eye
H33.123 Parasitic cyst of retina, bilateral
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
H40.40X0 Glaucoma secondary to eye inflammation, unspecified eye, stage unspecified
H40.51X0 Glaucoma secondary to other eye disorders, right eye, stage unspecified
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
H40.52X0 Glaucoma secondary to other eye disorders, left eye, stage unspecified
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
H40.89 Other specified glaucoma
H44.001 Unspecified purulent endophthalmitis, right eye
H44.002 Unspecified purulent endophthalmitis, left eye
H44.003 Unspecified purulent endophthalmitis, bilateral
H44.011 Panophthalmitis (acute), right eye
H44.012 Panophthalmitis (acute), left eye
H44.013 Panophthalmitis (acute), bilateral
H44.021 Vitreous abscess (chronic), right eye
H44.022 Vitreous abscess (chronic), left eye
H44.023 Vitreous abscess (chronic), bilateral
H44.111 Panuveitis, right eye
H44.112 Panuveitis, left eye
H44.113 Panuveitis, bilateral
H44.121 Parasitic endophthalmitis, unspecified, right eye
H44.122 Parasitic endophthalmitis, unspecified, left eye
H44.123 Parasitic endophthalmitis, unspecified, bilateral
H44.131 Sympathetic uveitis, right eye
H44.132 Sympathetic uveitis, left eye
H44.133 Sympathetic uveitis, bilateral
H44.19 Other endophthalmitis
S00.201A Unspecified superficial injury of right eyelid and periocular area, initial encounter
S00.202A Unspecified superficial injury of left eyelid and periocular area, initial encounter
S00.211A Abrasion of right eyelid and periocular area, initial encounter
S00.212A Abrasion of left eyelid and periocular area, initial encounter
S00.221A Blister (nonthermal) of right eyelid and periocular area, initial encounter
S00.222A Blister (nonthermal) of left eyelid and periocular area, initial encounter
S00.241A External constriction of right eyelid and periocular area, initial encounter
S00.242A External constriction of left eyelid and periocular area, initial encounter
S00.251A Superficial foreign body of right eyelid and periocular area, initial encounter
S00.252A Superficial foreign body of left eyelid and periocular area, initial encounter
S00.261A Insect bite (nonvenomous) of right eyelid and periocular area, initial encounter
S00.262A Insect bite (nonvenomous) of left eyelid and periocular area, initial encounter
S00.271A Other superficial bite of right eyelid and periocular area, initial encounter
S00.272A Other superficial bite of left eyelid and periocular area, initial encounter
S02.31XA Fracture of orbital floor, right side, initial encounter for closed fracture
S02.31XB Fracture of orbital floor, right side, initial encounter for open fracture
S02.32XA Fracture of orbital floor, left side, initial encounter for closed fracture
S02.32XB Fracture of orbital floor, left side, initial encounter for open fracture
S02.42XA Fracture of alveolus of maxilla, initial encounter for closed fracture
S02.42XB Fracture of alveolus of maxilla, initial encounter for open fracture
S02.81XA Fracture of other specified skull and facial bones, right side, initial encounter for closed fracture
S02.81XB Fracture of other specified skull and facial bones, right side, initial encounter for open fracture
S02.82XA Fracture of other specified skull and facial bones, left side, initial encounter for closed fracture
S02.82XB Fracture of other specified skull and facial bones, left side, initial encounter for open fracture
S05.01XA Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter
S05.02XA Injury of conjunctiva and corneal abrasion without foreign body, left eye, initial encounter
S05.90XA Unspecified injury of unspecified eye and orbit, initial encounter
T26.01XA Burn of right eyelid and periocular area, initial encounter
T26.02XA Burn of left eyelid and periocular area, initial encounter
T26.11XA Burn of cornea and conjunctival sac, right eye, initial encounter
T26.12XA Burn of cornea and conjunctival sac, left eye, initial encounter
T26.21XA Burn with resulting rupture and destruction of right eyeball, initial encounter
T26.22XA Burn with resulting rupture and destruction of left eyeball, initial encounter
T26.31XA Burns of other specified parts of right eye and adnexa, initial encounter
T26.32XA Burns of other specified parts of left eye and adnexa, initial encounter
T26.40XA Burn of unspecified eye and adnexa, part unspecified, initial encounter
T26.41XA Burn of right eye and adnexa, part unspecified, initial encounter
T26.42XA Burn of left eye and adnexa, part unspecified, initial encounter
T26.51XA Corrosion of right eyelid and periocular area, initial encounter
T26.52XA Corrosion of left eyelid and periocular area, initial encounter
T26.61XA Corrosion of cornea and conjunctival sac, right eye, initial encounter
T26.62XA Corrosion of cornea and conjunctival sac, left eye, initial encounter
T26.71XA Corrosion with resulting rupture and destruction of right eyeball, initial encounter
T26.72XA Corrosion with resulting rupture and destruction of left eyeball, initial encounter
T26.81XA Corrosions of other specified parts of right eye and adnexa, initial encounter
T26.82XA Corrosions of other specified parts of left eye and adnexa, initial encounter
T26.91XA Corrosion of right eye and adnexa, part unspecified, initial encounter
T26.92XA Corrosion of left eye and adnexa, part unspecified, initial encounter
T74.01XS Adult neglect or abandonment, confirmed, sequela
T74.02XS Child neglect or abandonment, confirmed, sequela
T74.11XS Adult physical abuse, confirmed, sequela
T74.12XS Child physical abuse, confirmed, sequela
T74.21XS Adult sexual abuse, confirmed, sequela
T74.22XS Child sexual abuse, confirmed, sequela
T74.31XS Adult psychological abuse, confirmed, sequela
T74.32XS Child psychological abuse, confirmed, sequela
T74.4XXS Shaken infant syndrome, sequela
T76.01XS Adult neglect or abandonment, suspected, sequela
T76.02XS Child neglect or abandonment, suspected, sequela
T76.11XS Adult physical abuse, suspected, sequela
T76.12XS Child physical abuse, suspected, sequela
T76.21XS Adult sexual abuse, suspected, sequela
T76.22XS Child sexual abuse, suspected, sequela
T76.31XS Adult psychological abuse, suspected, sequela
T76.32XS Child psychological abuse, suspected, sequela
T78.00XS Anaphylactic reaction due to unspecified food, sequela
T78.01XS Anaphylactic reaction due to peanuts, sequela
T78.02XS Anaphylactic reaction due to shellfish (crustaceans), sequela
T78.03XS Anaphylactic reaction due to other fish, sequela
T78.04XS Anaphylactic reaction due to fruits and vegetables, sequela
T78.05XS Anaphylactic reaction due to tree nuts and seeds, sequela
T78.06XS Anaphylactic reaction due to food additives, sequela
T78.07XS Anaphylactic reaction due to milk and dairy products, sequela
T78.08XS Anaphylactic reaction due to eggs, sequela
T78.09XS Anaphylactic reaction due to other food products, sequela
T78.1XXS Other adverse food reactions, not elsewhere classified, sequela
T78.2XXS Anaphylactic shock, unspecified, sequela
T78.3XXS Angioneurotic edema, sequela
T78.40XS Allergy, unspecified, sequela
T78.41XS Arthus phenomenon, sequela
T78.49XS Other allergy, sequela
T78.8XXS Other adverse effects, not elsewhere classified, sequela
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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Additional ICD-10 Information

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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.

Code Description
011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
071x Clinic - Rural Health
073x Clinic - Freestanding
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
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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.

Revenue codes only apply to providers who bill these services to the Part A MAC: Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC:

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.
Code Description
0510 Clinic - General Classification
0519 Clinic - Other Clinic
0520 Freestanding Clinic - General Classification
0761 Specialty Services - Treatment Room
0920 Other Diagnostic Services - General Classification
0929 Other Diagnostic Services - Other Diagnostic Service
0960 Professional Fees - General Classification
0982 Professional Fees - Outpatient Services
0983 Professional Fees - Clinic
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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
04/27/2023 R7

Revision Effective: 04/27/2023

Revision Explanation: Annual review, no changes were made.

04/14/2022 R6

Revision Effective: 04/14/2022

Revision Explanation: Annual review, no changes were made.

04/29/2021 R5

Revision Effective: N/A

Revision Explanation: Annual review, no changes were made.

10/01/2020 R4

R4
Revision Effective:10/01/2020
Revision Explanation: Codes H18.511-H18.513, H18.521-H18.523, H18.531-H18.533, and H18.541-H18.543 were left off during the annual ICD-10 review update and have been added to group 1 under ICD-10 codes.

10/01/2020 R3

R3
Revision Effective:10/01/2020
Revision Explanation: During annual ICD-10 review codes H18.50, H18.55, and H18.59 were deleted and replaced with the following codes: H18.501, H18.502, H18.503, H18.551, H18.552, H18.553, H18.591, H8.592, H18.593.

10/31/2019 R2

Revision Effective: n/a

Revision Explanation: annual review, no changes

10/31/2019 R1

R1

Revision Effective:10/31/2019

Revision Explanation: Added Part A and Part B claims filed to sections, additional documentation information, and other comments information in article text.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34393 - Ocular Photography - External
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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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
04/30/2024 05/09/2024 - N/A Currently in Effect View
11/15/2023 11/22/2023 - 05/08/2024 Superseded View
04/19/2023 04/27/2023 - 11/21/2023 Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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