LCD Reference Article Billing and Coding Article

Billing and Coding: Computerized Corneal Topography

A57699

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Draft Article
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

Article Information

General Information

Source Article ID
N/A
Article ID
A57699
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Computerized Corneal Topography
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
01/01/2024
Revision Ending Date
N/A
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

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33810 Computerized Corneal Topography. Please refer to the LCD for reasonable and necessary requirements and limitations.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier. 

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
99999 Not Applicable
N/A

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
Code Description
92025 Cptrized corneal topography
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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(116 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 92025

Group 1 Codes
Code Description
H11.001 Unspecified pterygium of right eye
H11.002 Unspecified pterygium of left eye
H11.003 Unspecified pterygium of eye, bilateral
H11.009 Unspecified pterygium of unspecified eye
H11.011 Amyloid pterygium of right eye
H11.012 Amyloid pterygium of left eye
H11.013 Amyloid pterygium of eye, bilateral
H11.019 Amyloid pterygium of unspecified eye
H11.021 Central pterygium of right eye
H11.022 Central pterygium of left eye
H11.023 Central pterygium of eye, bilateral
H11.029 Central pterygium of unspecified eye
H11.031 Double pterygium of right eye
H11.032 Double pterygium of left eye
H11.033 Double pterygium of eye, bilateral
H11.039 Double pterygium of unspecified eye
H11.041 Peripheral pterygium, stationary, right eye
H11.042 Peripheral pterygium, stationary, left eye
H11.043 Peripheral pterygium, stationary, bilateral
H11.049 Peripheral pterygium, stationary, unspecified eye
H11.051 Peripheral pterygium, progressive, right eye
H11.052 Peripheral pterygium, progressive, left eye
H11.053 Peripheral pterygium, progressive, bilateral
H11.059 Peripheral pterygium, progressive, unspecified eye
H11.061 Recurrent pterygium of right eye
H11.062 Recurrent pterygium of left eye
H11.063 Recurrent pterygium of eye, bilateral
H11.069 Recurrent pterygium of unspecified eye
H11.141 Conjunctival xerosis, unspecified, right eye
H11.142 Conjunctival xerosis, unspecified, left eye
H11.143 Conjunctival xerosis, unspecified, bilateral
H11.149 Conjunctival xerosis, unspecified, unspecified eye
H11.811 Pseudopterygium of conjunctiva, right eye
H11.812 Pseudopterygium of conjunctiva, left eye
H11.813 Pseudopterygium of conjunctiva, bilateral
H11.819 Pseudopterygium of conjunctiva, unspecified eye
H17.89 Other corneal scars and opacities
H17.9 Unspecified corneal scar and opacity
H18.10 Bullous keratopathy, unspecified eye
H18.11 Bullous keratopathy, right eye
H18.12 Bullous keratopathy, left eye
H18.13 Bullous keratopathy, bilateral
H18.451 Nodular corneal degeneration, right eye
H18.452 Nodular corneal degeneration, left eye
H18.453 Nodular corneal degeneration, bilateral
H18.459 Nodular corneal degeneration, unspecified eye
H18.461 Peripheral corneal degeneration, right eye
H18.462 Peripheral corneal degeneration, left eye
H18.463 Peripheral corneal degeneration, bilateral
H18.469 Peripheral corneal degeneration, unspecified eye
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
H18.609 Keratoconus, unspecified, unspecified eye
H18.611 Keratoconus, stable, right eye
H18.612 Keratoconus, stable, left eye
H18.613 Keratoconus, stable, bilateral
H18.619 Keratoconus, stable, unspecified eye
H18.621 Keratoconus, unstable, right eye
H18.622 Keratoconus, unstable, left eye
H18.623 Keratoconus, unstable, bilateral
H18.629 Keratoconus, unstable, unspecified eye
H18.711 Corneal ectasia, right eye
H18.712 Corneal ectasia, left eye
H18.713 Corneal ectasia, bilateral
H18.719 Corneal ectasia, unspecified eye
H52.211* Irregular astigmatism, right eye
H52.212* Irregular astigmatism, left eye
H52.213* Irregular astigmatism, bilateral
H52.219* Irregular astigmatism, unspecified eye
H52.221* Regular astigmatism, right eye
H52.222* Regular astigmatism, left eye
H52.223* Regular astigmatism, bilateral
H52.229* Regular astigmatism, unspecified eye
H53.2 Diplopia
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
T85.398A Other mechanical complication of other ocular prosthetic devices, implants and grafts, initial encounter
T85.398D Other mechanical complication of other ocular prosthetic devices, implants and grafts, subsequent encounter
T85.398S Other mechanical complication 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
T86.8481 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
Z98.41* Cataract extraction status, right eye
Z98.42* Cataract extraction status, left eye
Z98.49* Cataract extraction status, unspecified eye
Z98.83* Filtering (vitreous) bleb after glaucoma surgery status
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*ICD-10-CM codes H52.211, H52.212, H52.213, H52.219, H52.221, H52.222, H52.223, and H52.229 must be accompanied by diagnosis code Z98.41, Z98.42, Z98.49, or Z98.83. 

*Diagnosis codes Z94.7, Z98.41, Z98.42, Z98.49, and Z98.83 should not be billed as the primary diagnosis.

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

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

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
999x Not Applicable
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.

Code Description
99999 Not Applicable
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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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
01/01/2024 R2

Article revised and published on 01/25/2024 effective for dates of service on and after 01/01/2024 to reflect the Annual HCPCS/CPT Code Updates. The short description and/or the long description was changed for CPT code 92025. Depending on which description is used in this article, there may not be any change in how the code displays.

 

10/01/2020 R1

Revision Number: 1
Publication:  September 2020 Connections
LCR B2020/013

Explanation of revision:  Article revised and published on 10/01/2020 effective for dates of service on and after 10/01/2020 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10 code(s) have been deleted and therefore have been removed from the “ICD-10 Codes that Support Medical Necessity/Group 1 Codes:” section of this billing and coding article: H18.51, H18.52, H18.53, H18.54, H18.55, H18.59, T86.840, T86.841, and T86.848. The following ICD-10-CM code(s) have been added to the “ICD-10 Codes that Support Medical Necessity/Group 1 Codes:” section of this billing and coding article: 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, T86.8481, T86.8482, and T86.8483. Additional formatting changes have been made throughout the document. The effective date of this revision is based on date of service.

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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
L33810 - Computerized Corneal Topography
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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Updated On Effective Dates Status
01/19/2024 01/01/2024 - N/A Currently in Effect You are here
09/25/2020 10/01/2020 - 12/31/2023 Superseded View
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