注册 登录  
 加关注
   显示下一条  |  关闭
温馨提示!由于新浪微博认证机制调整,您的新浪微博帐号绑定已过期,请重新绑定!立即重新绑定新浪微博》  |  关闭

have a good time !!

mind act upon mind

 
 
 

日志

 
 

Ophthalmologic Techniques of Evaluating Glaucoma  

2012-03-04 15:32:43|  分类: ophthalmology 眼 |  标签: |举报 |字号 订阅

  下载LOFTER 我的照片书  |

https://www.bcidaho.com/providers/medical_policies/oth/mp_90306.asp

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Description

Glaucoma is a disease characterized by degeneration of the optic nerve (optic disc). Elevated intraocular pressure has long been thought to be the primary etiology, but the relationship between intraocular pressure and optic nerve damage varies among patients, suggesting a multifactorial origin. For example, some patients with clearly elevated intraocular pressure will show no optic nerve damage, while other patients with marginal or no pressure elevation will, nonetheless, show optic nerve damage. The association between glaucoma and other vascular disorders such as diabetes or hypertension suggests vascular factors may play a role in glaucoma. Specifically, it has been hypothesized that reductions in blood flow to the optic nerve may contribute to the visual field defects associated with glaucoma.

Conventional management of the patient with glaucoma principally involves drug therapy to control elevated intraocular pressures and serial evaluation of the optic nerve. Standard methods of evaluation include careful direct examination of the optic nerve using ophthalmoscopy or stereophotography, or evaluation of visual fields. There has been interest in developing more objective, reproducible techniques both to document optic nerve damage and to detect early changes in the optic nerve and retinal nerve fiber layer (RNFL) before the development of permanent visual field deficits. Specifically, evaluating changes in the thickness of the RNFL has been investigated as a technique to diagnose and monitor glaucoma. In addition, there has been interest in measuring ocular blood flow as a diagnostic and management tool for glaucoma. A variety of new techniques have been developed, as described here:

  1. Techniques to Evaluate the Optic Nerve/Retinal Nerve Fiber Layer (Note: This policy only addresses uses of these techniques related to glaucoma.)
    1. Confocal Scanning Laser Ophthalmoscopy 
      Confocal scanning laser ophthalmoscopy (CSLO) is a laser-based image acquisition technique, which is intended to improve the quality of the examination compared to standard ophthalmologic examination. A laser is scanned across the retina along with a detector system. Only a single spot on the retina is illuminated at any time, resulting in a high-contrast image of great reproducibility that can be used to estimate the thickness of the RNFL. In addition, this technique does not require maximal mydriasis, which may be a problem in patients with glaucoma. The Heidelberg Retinal Tomograph is probably the most common example of this technology.
    2. Scanning Laser Polarimetry
      The RNFL is birefringent, causing a change in the state of polarization of a laser beam as it passes. A 780-nm diode laser is used to illuminate the optic nerve. The polarization state of the light emerging from the eye is then evaluated and correlated with RNFL thickness. Unlike CSLO, scanning laser polarimetry (SLP) can directly measure the thickness of the RNFL. GDx? is a common example of a scanning laser polarimeter. GDx? contains a normative database and statistical software package to allow comparison to age-matched normal subjects of the same ethnic origin. The advantages of this system are that images can be obtained without pupil dilation, and evaluation can be done in about 10 minutes. Current instruments have added enhanced and variable corneal compensation technology to account for corneal polarization.
    3. Optical Coherence Tomography
      Optical coherence tomography (OCT) uses near-infrared light to provide direct cross-sectional measurement of the RNFL. The principles employed are similar to those used in B-mode ultrasound except light, not sound, is used to produce the 2-dimensional images. The light source can be directed into the eye through a conventional slit-lamp biomicroscope and focused onto the retina through a typical 78-diopter lens. This system requires dilation of the patient’s pupil. OCT? is an example of this technology.
  2. Pulsatile Ocular Blood Flow
    The pulsatile variation in ocular pressure results from the flow of blood into the eye during cardiac systole. Pulsatile ocular blood flow can thus be detected by the continuous monitoring of intraocular pressure. The detected pressure pulse can then be converted into a volume measurement using the known relationship between ocular pressure and ocular volume. Pulsatile blood flow is primarily determined by the choroidal vessels, particularly relevant to patients with glaucoma, since the optic nerve is supplied in large part by the choroidal circulation.
  3. Doppler Ultrasonography 

Color Doppler imaging has also been investigated as a technique to measure the blood velocity in the retinal and choroidal arteries.


Policy

Analysis of the optic nerve (retinal nerve fiber layer) in the diagnosis and evaluation of patients with glaucoma or glaucoma suspects may be considered medically necessary when using scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography.   Performance of this test more than once per year is considered not medically necessary by Blue Cross of Idaho.

The measurement of ocular blood flow, pulsatile ocular blood flow or blood flow velocity with Doppler ultrasonography is considered investigational in the diagnosis and follow-up of patients with glaucoma.


Policy Guidelines

Effective in January 2011, there is a new code for this testing:

92133: Scanning computerized ophthalmic diagnostic imaging, posterior segment; with interpretation and report, unilateral or bilateral; optic nerve

There is also a category III CPT code for measurement of ocular blood flow by repetitive ocular blood flow measurement:

0198T: Measurement of ocular blood flow by repetitive pressure sampling, with interpretation and report.

During 1999-2010, there was a CPT code 92135 which may have been used to describe scanning computerized ophthalmic diagnostic imaging. Code 92135 may have been used to describe optical coherence tomography (OCT) as well. Code 92135 was discontinued December 31, 2010.

Prior to the creation of 0198T, there was no specific CPT code describing measurement of ocular blood flow. CPT code 92120 (tomography with interpretation and report), 93875 (noninvasive physiologic studies of the extracranial arteries), or 92499 (unlisted ophthalmologic service) may have been used.

CPT code 93875 (noninvasive physiologic studies of extracranial arteries, complete bilateral study including Doppler ultrasound spectral analysis) may also be used to describe Doppler ultrasonography of the choroidal arteries.


Benefit Application

BlueCard/National Account Issues

Optic nerve/retinal nerve fiber analysis may be performed by both ophthalmologists and optometrists.

Some state or federal mandates (e.g., FEP) prohibit plans from denying technologies that are approved by the U.S. Food and Drug Administration (FDA) as investigational. In these instances, Plans may have to consider the coverage eligibility of FDA-approved technologies on the basis of medical necessity alone.


Rationale

The use of various techniques of retinal nerve fiber analysis (including scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography) for the diagnosis and management of glaucoma were addressed by a 2001 (1) and 2003 TEC Assessment. (2) The 2003 Assessment offered the following observations (2):

  • A variety of techniques to evaluate RNFLA were considered, including scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography. All 3 devices use different principles to directly evaluate the retinal nerve fiber layer. All 3 devices give multiple specific measurement of the retinal nerve fiber layer that can be followed up over time to evaluate a rate of change in the retinal nerve fiber layer. In theory, they are highly sensitive and can detect subtle changes to the retinal nerve fiber layer earlier than standard qualitative evaluations. The major potential benefit of these technologies is that they can provide a quantitative objective evaluation in contrast with the subjective evaluation provided by other methods of diagnosing and monitoring primary open angle glaucoma (POAG).
  • The Assessment evaluated whether adding RNFLA to other tests improves health outcomes. It is assumed that RNFLA would not influence decisions to begin treatment for suspected primary open angle glaucoma (POAG) when intraocular pressure is elevated or 2 of 3 conventional tests are positive. Conventional tests include ophthalmoscopic detection of atrophy of the optic nerve, visual field defect on perimetric testing, and increased intraocular pressure on tonometry. In patients without clear indications for topical medication, signs of optic nerve atrophy on RNFLA seen in advance of meeting other current diagnostic criteria for POAG may be used to begin early treatment. Using RNFLA to initiate early topical medication requires knowing how well RNFLA results predict the development of visual loss. If RNFLA is a poor predictor of future visual loss, its use could lead to errors in management, leading, for example, to overtreatment.
  • RNFLA may also play a role in monitoring patients who have already begun treatment for POAG. Patients showing a failed response to treatment on RNFLA may be referred to take a different class of topical medication or to undergo laser trabeculoplasty.
  • The best evidence would be direct evidence comparing outcomes of management guided by conventional tests with and without RNFLA analysis.

The 2003 TEC Assessment (2) offered the following conclusions:

  • No randomized trials compare the health outcomes of management guided by conventional tests alone to outcomes of management guided by conventional tests plus RNFLA in the detection or monitoring of POAG.
  • The best available evidence on using RNFLA to predict visual loss comes from a study of scanning laser ophthalmoscopy (i.e., Heidelberg retinal tomography, HRT), in which 21 patients progressed from ocular hypertension to glaucoma (converters) and 164 patients did not progress (nonconverters). Of the 21 converters, 13 had abnormal HRT results; in 11 of these, the tests were positive before development of visual field defects (average lead time was 5.4 months). Of the 164 nonconverters, 47 had abnormal results. (3)
  • The positive predictive value of HRT, given the available data, was 22%. The frequency of true positives and false positives in the Kamal et al study may depend on the duration of follow-up completed in this study, which was a mean of at least 33 months. If the frequency of true and false positives stays the same with more adequate follow-up, the consequence would be overtreatment in 78% of patients with a positive HRT. Additional follow-up is needed to show whether some false positives are late converters who become true positives.
  • Cross-sectional studies do not inform about the prediction of future visual loss. These studies can reveal whether RNFLA can detect prevalent cases of glaucoma. RNFLA does not detect all prevalent cases; it is falsely negative in 14%–36% of cases among recent cross-sectional studies using predetermined diagnostic criteria or blinded test interpretation.

Regarding pulsatile ocular blood flow or blood flow velocity (techniques not addressed by the TEC Assessment), there are similar deficiencies reported in the published literature. Specifically, no data from published clinical trials document how these devices should be incorporated into clinical practice and whether treatment decisions based on the use of these devices result in improved patient outcomes compared with the conventional methods of evaluation. Additional information is also needed to 1) document the association between blood flow and glaucoma; 2) determine the relevant vessels for study considering the complex blood supply to the optic nerve; and 3) establish the range of normal values, particularly in relation to other factors such as blood pressure, heart rate, and compliance of the blood vessels. (4-8)

Evidence Subsequent to the 2003 TEC Assessment (2004 through 9/2009)

Periodic literature searches (2004, 2005, etc.) were performed to identify relevant evidence focusing on longitudinal results, as emphasized in the TEC Assessment. Results are summarized as follows.

The CSLO Ancillary Study, a subset of the Ocular Hypertension Treatment Study (OHTS), was designed to determine whether annual optic disc topographic measurements can accurately predict visual field loss. (9) The OHTS randomized patients with elevated intraocular pressure to either topical hypotensive medication or observation. Baseline data reported from the CSLO Ancillary Study did not allow reaching conclusions about how well RNFL analysis measurements predict visual loss over time.

Follow-up of the CSLO Ancillary Study was reported in 2005. (10) Of 438 participants, 34% had abnormal CSLO values according to HRT criteria. The average interval between CSLO exams to POAG was 48.4 months (SD 25.2). Eyes not developing POAG were followed up a mean of 79.5 months (SD 20.8). Sensitivity of CSLO for development of POAG using HRT criteria was 55.6% (95% CI: 39.6 to 70.5), specificity 68.2% (95% CI: 63.5 to 72.5), and positive predictive value 13.5% (95% CI: 8.9 to 20.0). The investigators concluded that '[t]he current analysis did not directly determine whether the prediction model that includes baseline CSLO measurements is improved over the OHTS prediction model that includes baseline stereophotographic cup-disc ratio measurements…. Longer follow-up is required to evaluate the true predictive accuracy of CSLO measures.'

Longitudinal results have also been reported from the UCSD Diagnostic Innovations in Glaucoma Study (DIGS). (11, 12) In the first publication, eyes from 160 glaucoma suspects evaluated with SLP were followed up for 1.7 to 4.1 years. Visual field damage developed in 16 (10%) participants. Only relative risks for visual field damage were reported as opposed to sensitivities, specificities, and predictive values. (11) From 12 SLP parameters and a 13th calculated from those parameters, 3 were significantly associated with the visual field outcome in multivariate analyses (models were incorrectly specified owing to the small number of outcomes). In a subsequent report, 114 glaucoma suspects were examined with OCT (one eye per patient). (12) Over a 4.2-year average follow-up, 23 (20%) developed changes consistent with glaucoma. While the relative risk of developing glaucomatous changes was increased with thinner RNFL results (1.5-fold per 10 micrometers), sensitivities and specificities were not reported demonstrating clinical utility.

At Manchester Royal Eye Hospital (UK), HRT and GDx systems were evaluated in cross-sectional (98 normal controls and 152 patients with POAG) and longitudinal studies (240 at risk of developing glaucoma due to high intraocular pressure or fellow eye with POAG and 75 with POAG). (12) With specificity set at 95%, sensitivities of the HRT and GDx in detecting POAG were 59% and 45%, respectively, in the cross-sectional study. In the longitudinal study, patients were evaluated biannually over an average 3.5-year follow-up. Evidence of visual field defects developed in 72 of the at-risk group. Poor agreement was found between the HRT and GDx for development of visual field abnormalities. Although sensitivities might vary according to definitions for conversion to a visual field defect, among patients with baseline HRT and GDx abnormalities, sensitivities could be as low as 13% to 39%. The authors concluded that “on account of the fact that the HRT and GDx fail to detect a significant number of cases of conversion, they cannot provide a replacement for visual field examination.”

Kalaboukhova et al enrolled 55 patients with OHT and POAG (34 and 25, respectively) who were followed up for a median of 47 months (range, 22–86 months). (13) HRT was performed at entry (1998–2002) and re-examined between 2001 and 2005. Based on optic disc photographs, eyes were classified as progressive or stable — 22 showed progression. From 25 parameters evaluated, 5 were accompanied by statistically significant areas under the ROC curve. However, no adjustments were made for multiple comparisons; the sample was small and one of convenience.

Finally, the American Academy of Ophthalmology (AAO) POAG Suspect and POAG Preferred Practice Patterns recommend evaluating the optic nerve and retinal nerve fiber layer. (14,15) The documents also state that “[t]he preferred technique for optic nerve head and retinal nerve fiber layer evaluation involves magnified stereoscopic visualization (as with the slit-lamp biomicroscope), preferably through a dilated pupil.”

A technology assessment issued by the AAO in 2007 reviewed 159 studies published between January 2003 and February 2006, evaluating optic nerve head and RNFL devices used to diagnose or detect glaucoma progression. (16) The assessment concluded, “The information obtained from imaging devices is useful in clinical practice when analyzed in conjunction with other relevant parameters that define glaucoma diagnosis and progression.”

Medeiros and colleagues (17) compared case-control (cross-sectional) to longitudinal results assessing diagnostic accuracy of CSLO. They concluded that results from case-control studies “may not be applicable to the clinically relevant population.” No relevant publications of longitudinal studies were identified.

November 2009 Update
The policy was updated with a literature search using MEDLINE through September 2009. Numerous articles continue to describe findings from patients with known and suspected glaucoma using scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography. Studies note that abnormalities may be detected on these examinations before functional changes are noted. (18) These techniques have become incorporated into glaucoma care and are viewed as an additional piece of information that may be useful in the clinical management of these patients.

The data for use of ocular blood flow or blood flow velocity remain limited. Some recent publications described their use in studies comparing medication regimens in glaucoma. Others have suggested that these parameters may be helpful in understanding the variability in visual field changes in patients with glaucoma, i.e., this may help explain why patients with similar levels of intraocular pressure may develop markedly different visual impairments.

2010-2011 Update

The policy was updated with a literature search using MEDLINE through November 2010.

In terms of the medically necessary policy statements regarding diagnosis and management, none of the publications identified lead to a change in the existing policy statement. Studies continue to report on use of these techniques in patients with glaucoma/glaucoma suspects. In addition, studies report correlation of changes in retinal nerve fiber analysis and changes in visual fields. (19)

The literature review also did not identify studies that demonstrate the clinical utility for use of pulsatile ocular blood flow or blood flow velocity in patients with glaucoma. These techniques are used in evaluating various glaucoma treatments. A recent publication reported on color Doppler imaging (CDI) in normal and glaucomatous eyes. (20) Using data from reported studies, a weighted mean was derived for the peak systolic velocity, end diastolic velocity and Pourcelot's resistive index in the ophthalmic, central retinal and posterior ciliary arteries. Data from 3061 glaucoma patients and 1072 controls were included. The mean values for glaucomatous eyes were within one standard deviation of the values for controls for most CDI parameters. Methodological differences created inter-study variance in CDI values, complicating the construction of a normative database and limiting its utility. The authors noted that because the mean values for glaucomatous and normal eyes have overlapping ranges, caution should be used when classifying glaucoma status based on a single CDI measurement. These techniques remain investigational.

Finally, measurement of ocular blood flow has also been studied as a technique for evaluating patients with glaucoma. While reports of use have been longstanding, the report by Bafa from 2001 (21) is one example, the clinical impact of this technique is not known. Reports have commented on the complexity of these parameters (22) and have also noted that these technologies are not commonly used in clinical settings. (23) Thus, because the impact on health outcomes is not known, measurement of ocular blood flow is added as an investigational technique.

Physician Specialty Society and Academic Medical Center Input

In response to requests, input was received from 1 physician specialty society and 3 academic medical centers while this policy was under review in 2009. While the various physician specialty societies and academic medical centers may collaborate with and make recommendations during this process, through the provision of appropriate reviewers, input received does not represent an endorsement or position statement by the physician specialty societies or academic medical centers, unless otherwise noted. Three of the 4 reviewers providing input supported use of these techniques (CSLO, SLP, OCT) in the care of patients with glaucoma and those who are glaucoma suspects.

Reviewers provided data to demonstrate that this testing is equivalent to expert assessment of optic disc photography for both detecting glaucoma and showing disease progression. Reviewers also commented on favorable aspects of this testing. For example, in contrast to other glaucoma testing, these tests can be done more easily, e.g., this testing does not always need to done with dilated pupils and ambient light level may be (is) less critical. In addition, while serial stereophotographs of the optic nerves are considered by many as the gold standard, these are not always practical, especially for general ophthalmologists. This testing also requires less cooperation from the patient, which can be helpful in some older patients.

Summary
In summary, optic nerve analysis using SCLO, SLP, and OCT has become one additional test than may be used in the diagnosis and management of patients with glaucoma and those who are glaucoma suspects. These results are often considered along with other findings to make diagnostic and therapeutic decisions about glaucoma care. Thus, this testing may be considered medically necessary.

In contrast, data on use of ocular blood flow, pulsatile ocular blood flow, and/or blood flow velocity are currently lacking. Their relationship to clinical outcomes is not known; their use remains investigational.

References:

  1. Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Retinal nerve fiber analysis for the diagnosis and management of glaucoma. TEC Assessments 2001; Volume 16, Tab 13.
  2. Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Retinal nerve fiber layer analysis for the diagnosis and management of glaucoma. TEC Assessments 2003; Volume 18, Tab 7.
  3. Kamal DS, Garway-Heath DF, Hitchings RA et al. Use of sequential Heidelberg retina tomograph images to identify changes at the optic disc in ocular hypertensive patients at risk of developing glaucoma. Br J Ophthalmol 2000; 84(9):993-8.
  4. Cioffi GA. Three assumptions: ocular blood flow and glaucoma. J Glaucoma 1998; 7(5):299-300.
  5. Fontana L, Poinoosawmy D, Bunce CV et al. Pulsatile ocular blood flow investigation in asymmetric normal tension glaucoma and normal subjects. Br J Ophthalmol 1998; 82(7):731-6.
  6. James CB. Pulsatile ocular blood flow. Br J Ophthalmol 1998; 82(7):720-1.
  7. Kaiser HJ, Schoetzau A, Stumpfig D et al. Blood-flow velocities of the extraocular vessels in patients with high-tension and normal-tension primary open-angle glaucoma. Am J Ophthalmol 1997; 123(3):320-7.
  8. Rankin SJ, Walman BE, Buckley AR et al. Color Doppler imaging and spectral analysis of the optic nerve vasculature in glaucoma. Am J Ophthalmol 1995; 119(6):685-93.
  9. Zangwill LM, Weinreb RN, Berry CC et al. The confocal scanning laser ophthalmoscopy ancillary study to the ocular hypertension treatment study: study design and baseline factors. Am J Ophthalmol 2004; 137(2):219-27.
  10. Zangwill LM, Weinreb RN, Beiser JA et al. Baseline topographic optic disc measurements are associated with the development of primary open-angle glaucoma: the Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study. Arch Ophthalmol 2005; 123(9):1188-97.
  11. Mohammadi K, Bowd C, Weinreb RN et al. Retinal nerve fiber layer thickness measurements with scanning laser polarimetry predict glaucomatous visual field loss. Am J Ophthalmol 2004; 138(4):592-601.
  12. Lalezary M, Medeiros FA, Weinreb RN et al. Baseline optical coherence tomography predicts the development of glaucomatous change in glaucoma suspects. Am J Ophthalmol 2006; 142(4):576-82.
  13. Kalaboukhova L, Fridhammar V, Lindblom B. Glaucoma follow-up by the Heidelberg Retina Tomograph. Graefes Arch Clin Exp Ophthalmol. 2006 Jun; 244(6):654-62.
  14. American Academy of Ophthalmology. (2005). Primary open-angle glaucoma suspect. Preferred practice pattern. San Francisco: American Academy of Ophthalmology. Available at: http://www.aao.org/education/library/ppp/upload/Primary_Open_Angle_Glaucoma_Suspect-2.pdf
  15. American Academy of Ophthalmology. (2005). Primary open-angle glaucoma. Preferred practice pattern. San Francisco: American Academy of Ophthalmology. Available at: http://www.aao.org/education/library/ppp/upload/Primary_Open_Angle_Glaucoma-2.pdf
  16. Lin SC, Singh K, Jampel HD et al. Optic nerve head and retinal nerve fiber layer analysis: a report by the American Academy of Ophthalmology. Ophthalmology 2007; 114(10):1937-49.
  17. Medeiros FA, Ng D, Zangwill LM et al. The effects of study design and spectrum bias on the evaluation of diagnostic accuracy of confocal scanning laser ophthalmoscopy in glaucoma. Invest Ophthalmol Vis Sci 2007; 48(1):214-22.
  18. Chauhan BC, Hicolela MT, Artes PH. Incidence and rates of visual field progression after longitudinally mesured optic disc change in glaucoma. Ophthalmology 2009: 116(11):2110-8. 
  19. Grewal DS, Sehi M, Greenfield DS, et al. Comparing rates of retinal nerve fibre layer loss with GDxECC using different methods of visual-field progression. Br J Ophthalmol 2010 Sep 9 (Epub alhead of print).
  20. Rusia D, Harris A, Pernic A et al. Feasibilty of creating a normative database of colour Doppler imaging parameters in glaucomatous eyes and controls. Br J Ophthalmol 2010 Nov 24 (Epub ahead of pirnt).
  21. Bafa M, Lambrinakis I, Dayan M et al. Clinical comparison of the measurement of the IOP with the ocular blood flow tonometer, the Tonopen XL and the Goldmann applanation tonometer . Acta Ophthalmol Scand 2001; 79(1):15-8.
  22. Schmidl D, Garhofer G, Schmetterer L. The complex interaction between ocular perfusion pressure and occular blood flow – Relevance for glaucoma. Exp Eye Res 2919 Sep 22 (Epub ahead of print).
  23. Harris A, Kagermann L, Ehrlich R et al. Measuring and interpreting ocular blood flow and metablism in glaucoma. Can J Ophthalmol 2008; 43(3):328-36.

 

Codes

Number

Description

CPT  92132 Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral (new code 1/1/2011)
   92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve (new code 1/1/2011)
   92134 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina (new code 1/1/2011)
92135  Scanning computerized ophthalmic diagnostic imaging (e.g., scanning laser) with interpretation and report, unilateral (deleted code 1/1/2011)
  93875  Non-invasive physiologic studies of extracranial arteries, complete bilateral study (e.g., periorbital flow direction with arterial compression, ocular pneumoplethysmography, Doppler ultrasound spectral analysis) 
  92120  Tonography with interpretation and report, recording indentation tonometer method or perilimbal suction method 
0198T Measurement of ocular blood flow by repetitive intraocular pressure sampling, with interpretation and report.
ICD-9 Diagnosis  190.5-190.8 Malignant neoplasm retina range
  115.02 Histoplasma capsulatum retinitis
  190.6 Malignant neoplasm of choroid
  190.8 Malignant neoplasm other specified sites of eye
  224.5-224.6 Benign neoplasm of retina, choroid
  228.03 Hemangioma of retina
  361.00-363.35 disorders, disease of retina range
  363.40-363.43 choroidal degenerations range
  363.63 choroidal rupture
  363.70-363.72 choroidal detachment range
  364.22 glaucomatocycstic crises
364.53 pigmentary iris degeneration
  364.73-364.74 adhesions and disruptions of iris and ciliary body range
  364.77 recession of chamber angle
  365.00-365.9 borderline glaucoma range
   365.41-365.44 Glaucoma associated with congenital anomalies, dystrophies, and systemic syndromes
  365.51 – 365.59 Glaucoma associated with disorders of the lens
   365.60 - 365.65 Glaucoma associated with other ocular disorders
  365.81 - 365.89 Other specified forms of glaucoma
  365.9 Unspecified glaucoma
ICD-10-CM (effective 10/1/13) H40.141 -H40.149 Capsular glaucoma with pseudoexfoliation of lens, code range
  H40.30 - H40.33 Glaucoma secondary to eye trauma, code range
  H40.40 - H40.43 Glaucoma secondary to eye inflammation, code range
  H40.89 Other specified glaucoma
  H40.9 Unspecified glaucoma
  H42 Glaucoma in disease classified elsewhere
  Z01.00 - Z01.01 Encounter for examination of eyes and vision
ICD-10-PCD (effective 10/1/13)    ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this testing.
HCPCS  No code   
Type of Service  Vision 
Place of Service  Physician’s office 


Index

Doppler Utrasonography, Glaucoma
GDx
Glaucoma Scope
HeidelbergRetinal Tomograph
Nerve Fiber Analyzer
Ophthalmologic Evaluation, Glaucoma
Optic Nerve Head Analyzer
Optical Coherence Tomography
Pulsatile Ocular Blood Flow
Retinal Nerve Fiber Layer Analysis
Scanning Laser Ophthalmoscope
Scanning Laser Polarimetry
TopSS Device


Policy History

Date Action Reason
04/1/98 Add to Vision section New policy
11/15/98 Coding update 99 CPT coding release
07/16/99 Replace policy Updated; new technologies discussed
11/20/01 Replace policy Updated with reference to 2001 TEC Assessment; no change in policy statement
07/17/03 Replace policy Updated with discussion of 2003 TEC Assessment focusing on retinal nerve fiber analysis
07/15/04 Replace policy Updated with retinal nerve fiber layer analysis literature review; no change in policy statement
12/14/05 Replace policy Updated with literature review; no change in policy statement
12/12/06 Replace policy Policy updated with literature review through October 2006; no changes in policy statement. Reference numbers 12 -15 added
08/01/07 updated to local policy policy statement changed; GDX as a scanning methodology however, may be considered medically necessary in the analysis of the retinal nerve fiber layer only in disease of the retina.
05/06/08 updated policy  revised policy section; changed 'analysis of the retinal nerve fiber layer only in disease of the retina' to 'evaluation of diseases of the retina.'
2/1/09 coding update  added new 2009 code 0198T
07/20/09 coding update added diagnoses to range of codes
01/18/10 Replace policy Policy updated and clinical input reviewed. Reference number 18 added. Policy statement changed to indicate that testing using scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography may be considered medically necessary in patients with glaucoma and glaucoma suspects. Policy statement regarding optic nerve head analyzers removed
01/13/11 Replace policy Policy updated with literature review, references 19-23 added, ocular blood flow added as investigational, no other changes in policy statements
  评论这张
 
阅读(389)| 评论(1)
推荐 转载

历史上的今天

在LOFTER的更多文章

评论

<#--最新日志,群博日志--> <#--推荐日志--> <#--引用记录--> <#--博主推荐--> <#--随机阅读--> <#--首页推荐--> <#--历史上的今天--> <#--被推荐日志--> <#--上一篇,下一篇--> <#-- 热度 --> <#-- 网易新闻广告 --> <#--右边模块结构--> <#--评论模块结构--> <#--引用模块结构--> <#--博主发起的投票-->
 
 
 
 
 
 
 
 
 
 
 
 
 
 

页脚

网易公司版权所有 ©1997-2017