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Ophthalmology Diagnosis Codes (ophthal cd)

By Jacob Anderson,2014-04-26 19:56
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Ophthalmology Diagnosis Codes (ophthal cd)

    ophthal cd Ophthalmology: Diagnosis Codes 1

This section lists the ICD-9-CM diagnosis codes required to bill certain ophthalmological services and

    eye appliances (frames, lenses, contact lenses). Diagnosis codes must be entered in the Diagnosis or Nature of Illness or Injury field (Box 21) of the CMS-1500 claim. For policy information, refer to the

    Ophthalmology section in this manual or the Professional Services, Eye Appliances, Eyeglass Frames, Eyeglass Lenses, Contact Lenses and Low Vision Aids sections in the Part 2 Vision Care manual.

    Note: Primary and secondary diagnosis codes are placed in the area indicated by 21.1 and 21.2,

    respectively, on the CMS-1500 claim form.

The following CPT-4 codes and HCPCS codes must be billed in conjunction with a corresponding

    primary diagnosis code and, when applicable, one of the corresponding secondary diagnosis codes in the

    chart below:

CPT-4/HCPCS

    Codes Description ICD-9-CM Codes

    J7312 Injection, dexamethasone 362.35, 362.36, 362.83

    intravitreal implant, 0.1 mg

    V2020 Frames (quantity two, recipient Primary:

    younger than 38 years of age on the 367.51 367.53, 367.9, 378.35 or date of service) 378.84

    V2020 Frames (quantity two, recipient Primary: 367.4

    38 years of age or older on the date of and service)

    Secondary: 368.10, 368.13 368.16,

    368.8, 368.9

    V2100 V2121, Eyeglass lenses, single vision, Primary:

    V2410 Counties 40, 41 and 42 (quantity 367.51 367.53, 367.9, 378.35, 378.84 greater than two, recipient younger

    than 38 years of age on the date of

    service)

    V2100 V2121, Eyeglass lenses, single vision, Primary: 367.4

    V2410 Counties 40, 41 and 42 (quantity and greater than two, recipient 38 years of

    age or older on the date of service) Secondary: 368.10, 368.13 368.16,

    368.8 or 368.9

    V2200 V2221, Eyeglass lenses, bifocal, Counties 40, Primary:

    V2430 41 and 42 (recipient younger than 38 367.51 367.53, 367.9, 378.35, 378.84 years of age on the date of service)

    V2300 V2321 Eyeglass lenses, trifocal, Counties 40, Primary:

    41 and 42 (recipient younger than 38 367.51 367.53, 367.9, 378.35, 378.84 years of age on the date of service)

2 Ophthalmology: Diagnosis Codes February 2011

ophthal cd

    2

    CPT-4/HCPCS

    Codes Description ICD-9-CM Codes

    V2599 Contact lens, other type (Use for 370.2 370.21, 370.23 370.24,

    Bandage Contact Lenses) 370.34 370.35, 370.8 370.9,

    371.20 371.23, 371.42 371.43,

    371.46, 371.50 371.58, 374.0, 374.05

    918.1

    V2630 V2632 Intraocular lens 366.0 366.9, 379.31 379.34,

    743.30 743.35, 996.53, V43.1, V45.61 V2710 Slab off prism, glass or plastic, 367.31, 367.32

    per lens

    V2744, V2745, V2744 (tint, photochromic, per lens) 054.4 054.49, 115.02, 115.12, 115.92,

    V2755 135, 140 239, 242.0, 250 250.8, 270.2, 299.0, 332, 332.1, 340,

    345 345.9, 346 346.9, V2745 (addition to lens, tint, any color,

    360 360.9, 361 362.57, solid, gradient or equal, excludes

    362.7 362.9, 363 363.22, photochromatic, any lens material, per

    363.6 363.72, 364 364.9, lens)

    365.0 365.9, 366.0 366.9, 367.51 367.53, 368.4 368.47,

    369 369.9, 370 370.9, 371 371.9, V2755 (UV lens, per lens) 372.4 372.45, 372.51,

    373.00 373.02, 374 374.23, 375.15,

    377 377.9, 379 379.19,

    379.2 379.29, 379.3 379.39,

    379.4 379.49, 379.5 379.59, 710.0,

    743.3 743.39, 743.45 743.46, 758.0,

    759.6, 871 871.9, 921 921.9, V43.1,

    V58.69

    V2770 Occluder lens, per lens 369.0 369.99

    65205 Removal of foreign body, external eye, 918.2, 918.9, 930.1, 930.8

    conjunctival superficial

    65210 Removal of foreign body, external eye, 372.54, 372.56, 930.1, 930.8

    conjunctival embedded

    65220 Removal of foreign body, corneal, 918.1, 918.9, 930.0

    without slit lamp

    65222 Removal of foreign body, corneal, with 918.1, 918.9, 930.0

    slit lamp

    67820 Correction of trichiasis; epilation, 053.20, 076 076.9, 374.0 374.05,

    by forceps only 374.54, 374.89, 379.91, 694.61,

    695.10 695.15, 695.19, 743.63, 918.1,

    940.0 940.9, 941.0 941.9

2 Ophthalmology: Diagnosis Codes August 2010

    ophthal cd

    3 CPT-4/HCPCS

    Codes Description ICD-9-CM Codes

    67938 Removal of foreign body, eyelid 374.86, 379.91, 918.0, 930.1 930.2,

    930.8 930.9, 998.4

    68761 Closure of lacrimal punctum, by 370.21, 370.23, 370.33 370.34,

    plug, each 370.80, 370.90, 371.42, 374.41, 375.15,

    375.16, 710.20

    68801 Dilation of lacrimal punctum, with 375.22, 375.32, 375.42, 375.43, 375.52,

    or without irrigation 375.56

    76514 Ophthalmic ultrasound, diagnostic; 364.22, 364.77, 365.00 365.9, 371.03,

    B-scan and quantitative A-scan 371.20, 371.23, 371.57, 371.58

    performed during the same patient

    encounter; corneal pachymetry,

    unilateral or bilateral [determination of

    corneal thickness]

    92004, 92014 Comprehensive eye examination 250 250.9, 368.10 368.15,

    (when billing for second exam within 368.40 368.47, 379.91 379.93,

    24 months) 648.8, 775.1, 784.0, 790.2,

    E931.3 E931.4, V67.51 92020 Gonioscopy (separate procedure) 135.0, 360.50 360.53, 360.59,

    360.60 360.63, 360.69,

    362.01 362.02, 362.11, 362.16,

    362.29 362.31, 362.35 362.36,

    362.84, 363.70 363.72,

    364.00 364.77, 364.81 364.90,

    365.00 365.04,

    365.10 365.15, 365.20 365.24,

    365.31 365.32, 365.41 365.44,

    365.51 365.59, 365.60 365.65,

    365.81 365.83, 365.89, 365.90,

    366.16, 366.53, 371.13, 377.14, 379.31,

    743.41 743.49, 921.3, 996.69, V43.1

2 Ophthalmology: Diagnosis Codes March 2010

ophthal cd

    4

    CPT-4/HCPCS

    Codes Description ICD-9-CM Codes

    92081, 92082, Visual field examination 010.90, 017.3, 042, 052.7, 053.2, 054.40,

    92083 054.44, 054.49, 056.79,

    090.0 090.49, 094.83 094.85, 112.89,

    115.02, 115.12, 115.92, 117.7, 172.1,

    190.0 190.1, 190.5 190.6, 190.8,

    191.0 191.9, 194.3,

    224.5 224.6, 225.0 225.1,

    227.3, 228.03, 237.0, 237.9,

    249.50 249.51, 250.50 250.53,

    250.62, 300.11, 340, 341.1,

    346.00 346.99, 360.21,

    361.0 361.07, 361.10 361.14, 361.19,

    362.70, 363.20, 364.41,

    365.00 365.04, 365.1 365.15,

    365.2 365.24, 365.3, 365.31 365.32,

    365.4 365.44, 365.5 365.52,

    365.59, 365.6, 365.60 365.65,

    365.8 365.82, 365.89, 365.9, 368.10,

    368.15 368.16, 368.40 368.46,

    368.60, 368.68, 369.4, 369.9,

    374.30 374.34, 374.87,

    377.00 377.79, 379.91, 433.11, 434.10,

    435.0 437.1, 446.5, 743.56, 921.3,

    E931.3, E931.4, V58.69, V67.51 92100 Serial tonometry 365.0 365.02, 365.04, 365.1 365.15,

    365.2 365.23, 365.31,

    365.51 365.52, 365.62 365.65 92132 Computerized ophthalmic 190.0; 190.4; 224.0; 224.4; 364.51-

    diagnostic imaging, anterior 364.59,; 364.60-364.64; 364.70-364.77;

    segment 364.81-364.82; 364.89; 365.02; 365.20-

    365.24; 365.41-365.44; 365.51-365.59;

    365.60-365.65; 365.81-365.89; 370.04-

    370.06; 371.03; 371.71-371.73; 379.31;

    379.33; 996.51; 996.53; 996.69

    190.8; 191.0-198.3; 224.5-224.6; 228.03; 92133 Computerized ophthalmic 364.22; 364.53; 364.73; 364.77; 365.00-diagnostic imaging, posterior 365.99; 367.74; 368.40-368.47; 376.00-segment, optic nerve 376.9; 377.00-377.04; 377.10-377.16;

    377.21-377.24; 377.41-377.49; 377.51-

    377.54; 377.61-377.75; 377.9; 743.20-

    743.22; 743.57; 854.0-854.16; 854.19;

    921.3

2 Ophthalmology: Diagnosis Codes December 2011

    ophthal cd

    5

    CPT-4/HCPCS

    Codes Description ICD-9-CM Codes

    92134 Computerized ophthalmic 115.92; 190.5-190.6; 191.0-198.3;

    diagnostic imaging, posterior 224.5-224.6; 228.03; 360.21; 361.00-

    segment, retina 361.19; 361.2; 361.30-361.33; 361.81;

    361.9; 362.00-362.07; 362.10-362.18;

    362.21-362.29; 362.30-362.37; 362.40-

    362.43; 362.50-362.57; 362.73; 362.81-

    362.82; 362.83; 362.85; 363.00-363.35;

    363.40-363.43; 363.63; 363.70-363.72;

    379.11-379.19; 379.21-379.29; 743.58;

    854.0-854.1; 921.3

    92225 Extended ophthalmoscopy 115.92, 130.2, 190.0, 190.5 190.6,

    198.89, 224.5 224.6, 250.50 250.53,

    360.50 360.59, 360.60 360.69,

    361.01 361.07, 361.10 361.19,

    361.2, 361.30 361.33,

    361.81 361.89, 361.9,

    362.01 362.07, 362.10 362.18,

    362.21 362.27, 362.29 362.37,

    362.40 362.43, 362.50 362.57,

    362.60 362.66, 362.7 362.77,

    362.81, 362.83, 362.89,

    363.00 363.08, 363.10 363.15,

    363.20 363.22, 363.30 363.35,

    363.40 363.43, 363.50 363.57,

    363.61 363.63, 363.70 363.72,

    363.8, 363.9, 365.0 365.9, 376.6,

    379.23, 379.26, 871.5 871.6

    92226 Subsequent ophthalmoscopy 115.92, 130.2, 190.0, 190.5 190.6,

    198.89, 224.5 224.6, 250.50 250.53,

    360.50 360.59, 360.60 360.69,

    361.01 361.07, 361.10 361.19,

    361.2, 361.30 361.33,

    361.81 361.89, 361.9,

    362.01 362.07, 362.10 362.18,

    362.21 362.27, 362.29 362.37,

    362.40 362.43, 362.50 362.57,

    362.60 362.66, 362.7 362.77,

    362.81, 362.83, 362.89,

    363.00 363.08, 363.10 363.15,

    363.20 363.22, 363.30 363.35,

    363.40 363.43, 363.50 363.57,

    363.61 363.63, 363.70 363.72,

    363.8, 363.9, 365.0 365.9, 376.6,

    379.23, 379.26, 871.5 871.6

    2 Ophthalmology: Diagnosis Codes December 2011

ophthal cd

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    CPT-4/HCPCS

    Codes Description ICD-9-CM Codes

    92250 Fundus photography 094.83 094.84, 115.92, 130.2, 135,

    190.5 190.6, 224.5 224.6, 360.00,

    360.54 360.55, 360.64 360.65,

    361.01 361.07, 361.10 361.19,

    361.2, 361.30 361.33,

    361.81 361.89, 361.9,

    362.01 362.02, 362.10 362.18,

    362.21, 362.29, 362.30 362.37,

    362.40 362.43, 362.50 362.57,

    362.60 362.66, 362.70 362.77,

    362.81 362.85, 363.00 363.08,

    363.10 363.15, 363.20 363.22,

    363.30 363.35, 363.40 363.43,

    363.50 363.57, 363.61 363.72,

    365.00 365.9, 377.00 377.63,

    379.23, 871.1

    92340, 92352 Eyeglass dispensing, single vision, Primary:

    (quantity greater than two, recipient 367.51 367.53, 367.9, 378.35 or younger than 38 years of age on the 378.84 date of service)

    92340, 92352 Eyeglass dispensing, single vision, Primary: 367.4

    (quantity greater than two, recipient 38 Secondary: 368.10, 368.13 368.16, years of age or older on the date of 368.8 or 368.9 service)

    92341, 92353 Eyeglass dispensing, bifocal, recipient Primary:

    younger than 38 years of age on the 367.51 367.53, 367.9, 378.35 or date of service 378.84

    92342 Eyeglass dispensing, trifocal, recipient Primary:

    younger than 38 years of age on the 367.51 367.53, 367.9, 378.35 or date of service 378.84

    92499 Unlisted ophthalmological service or 369.00 369.40

    procedure when billed for a low vision

    examination

2 Ophthalmology: Diagnosis Codes December 2011

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