local coverage determination for visual fields testing

Contractor Name Contract Type ContractNumber Jurisdiction State(s)

National Government Services, Inc. MAC - Part A 06101 - MAC A N/A IllinoisNational Government Services, Inc. MAC - Part B 06102 - MAC B N/A IllinoisNational Government Services, Inc. MAC - Part A 06201 - MAC A N/A MinnesotaNational Government Services, Inc. MAC - Part B 06202 - MAC B N/A MinnesotaNational Government Services, Inc. MAC - Part A 06301 - MAC A N/A WisconsinNational Government Services, Inc. MAC - Part B 06302 - MAC B N/A Wisconsin

National Government Services, Inc. A and B and HHHMAC 13101 - MAC A J - K Connecticut

National Government Services, Inc. A and B and HHHMAC 13102 - MAC B J - K Connecticut

National Government Services, Inc. A and B and HHHMAC 13201 - MAC A J - K New York - Entire

State

National Government Services, Inc. A and B and HHHMAC 13202 - MAC B J - K New York - Downstate

National Government Services, Inc. A and B and HHHMAC 13282 - MAC B J - K New York - Upstate

National Government Services, Inc. A and B and HHHMAC 13292 - MAC B J - K New York - Queens

National Government Services, Inc. A and B and HHHMAC 14111 - MAC A J - K Maine

National Government Services, Inc. A and B and HHHMAC 14112 - MAC B J - K Maine

National Government Services, Inc. A and B and HHHMAC 14211 - MAC A J - K Massachusetts

National Government Services, Inc. A and B and HHHMAC 14212 - MAC B J - K Massachusetts

National Government Services, Inc. A and B and HHHMAC 14311 - MAC A J - K New Hampshire

National Government Services, Inc. A and B and HHHMAC 14312 - MAC B J - K New Hampshire

National Government Services, Inc. A and B and HHHMAC 14411 - MAC A J - K Rhode Island

National Government Services, Inc. A and B and HHHMAC 14412 - MAC B J - K Rhode Island

National Government Services, Inc. A and B and HHHMAC 14511 - MAC A J - K Vermont

National Government Services, Inc. A and B and HHHMAC 14512 - MAC B J - K Vermont

LCD ID Original Effective Date

Local Coverage Determination (LCD):Visual Fields Testing (L33574)

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LCD InformationDocument Information

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https://www.cms.gov/medicare-coverage-database/staticpages/contractor-details.aspx?ContrId=269&ver=1
























L33574

Original ICD-9 LCD IDL26367

LCD TitleVisual Fields Testing

AMA CPT / ADA CDT / AHA NUBC Copyright StatementCPT only copyright 2002-2015 American MedicalAssociation. All Rights Reserved. CPT is a registeredtrademark of the American Medical Association.Applicable FARS/DFARS Apply to Government Use. Feeschedules, relative value units, conversion factorsand/or related components are not assigned by theAMA, are not part of CPT, and the AMA is notrecommending their use. The AMA does not directly orindirectly practice medicine or dispense medicalservices. The AMA assumes no liability for datacontained or not contained herein.

The Code on Dental Procedures and Nomenclature(Code) is published in Current Dental Terminology(CDT). Copyright © American Dental Association. Allrights reserved. CDT and CDT-2016 are trademarks ofthe American Dental Association.

UB-04 Manual. OFFICIAL UB-04 DATA SPECIFICATIONSMANUAL, 2014, is copyrighted by American HospitalAssociation (“AHA”), Chicago, Illinois. No portion ofOFFICIAL UB-04 MANUAL may be reproduced, sorted ina retrieval system, or transmitted, in any form or byany means, electronic, mechanical, photocopying,recording or otherwise, without prior express, writtenconsent of AHA.” Health Forum reserves the right tochange the copyright notice from time to time uponwritten notice to Company.

For services performed on or after 10/01/2015

Revision Effective DateFor services performed on or after 01/01/2016

Revision Ending DateN/A

Retirement DateN/A

Notice Period Start DateN/A

Notice Period End DateN/A

80.9 Computer Enhanced Perimetry.

CMS National Coverage Policy Language quoted from Centers for Medicare and Medicaid Services (CMS), NationalCoverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout thepolicy. NCDs and coverage provisions in interpretive manuals are not subject to the Local CoverageDetermination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, anadministrative 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 necessaryfor 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 theclaim.

Code of Federal Regulations:

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

CMS Publications:

CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1:


http://localcoverage.cms.gov/mcd_archive/m_d.asp?id=26367

1. The patient has a disorder of the eyelid(s) potentially affecting the visual field(s).2. The patient has a visual field defect detected on gross visual field testing (e.g., confrontational testing).3. The patient has a documented diagnosis of glaucoma.

It should be noted that the progression of, and effects of treatment on glaucoma can be monitored onlythrough periodic visual field testing. The frequency of such examinations is dependent on changes inintraocular pressure (IOP), retinal damage and changes at the optic disc.

4. The patient is suspected of having glaucoma; signs include increased intraocular pressure, asymmetric IOPmeasurements, notching or thinning of the neuroretinal rim, splinter hemorrhages and asymmetricappearance of the discs.

5. The patient has a documented disorder of the optic nerve, the retina or the neurologic visual pathway.6. The patient has a recent intracranial hemorrhage, an intracranial mass or a recent increased intracranial

pressure measurement (with or without visual symptoms).7. The patient has a recent occlusion / stenosis of cerebral or precerebral arteries.8. The patient has a history of a cerebral aneurysm, pituitary or occipital tumor potentially affecting the

visual fields.9. The patient is being evaluated for buphthalmos, congenital anomalies of the posterior segment or

congenital ptosis.10. The patient has a disorder of the orbit potentially affecting the visual field.11. The patient has sustained a significant eye injury.12. The patient has unexplained visual loss.13. The patient has a pale or swollen optic nerve on a recent examination.14. The patient is having new functional limitations which may be due to visual field loss (e.g., reports by

family of patient bumping into objects). (change to e.g.,)15. The patient is taking a medication with a high risk of affecting the visual system (e.g., Plaquenil).16. The patient is being evaluated for macular degeneration, or has experienced central vision loss (< 20/70).

(Repeated examinations for diagnosis of macular degeneration or central vision loss are not medicallynecessary unless changes in vision are documented, or to evaluate the results of a surgical intervention).

011x Hospital Inpatient (Including Medicare Part A)

Coverage GuidanceCoverage Indications, Limitations, and/or Medical Necessity

Abstract:

Visual field testing detects defects in the field of vision, testing the function of the retina, optic nerve and opticpathways. Formal visual field tests are generally performed using automated perimetry, i.e., measurement of theability to see points of light at varying locations on a curved surface.

Indications:

Visual field examinations are considered medically necessary for the conditions listed below:

Limitations:

Gross visual field testing (e.g., confrontation testing) is a part of general ophthalmological service and should notbe reported separately.

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Coding InformationBill 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 policy does not apply to that Bill Type. Complete absence of allBill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equallyto all claims.


012x Hospital Inpatient (Medicare Part B only)013x Hospital Outpatient021x Skilled Nursing - Inpatient (Including Medicare Part A)022x Skilled Nursing - Inpatient (Medicare Part B only)023x Skilled Nursing - Outpatient071x Clinic - Rural Health073x Clinic - Freestanding074x Clinic - Outpatient Rehabilitation Facility (ORF)075x Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)077x Clinic - Federally Qualified Health Center (FQHC)085x Critical Access Hospital

0510 Clinic - General Classification0519 Clinic - Other Clinic0761 Specialty Services - Treatment Room0920 Other Diagnostic Services - General Classification

92081VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT;LIMITED EXAMINATION (EG, TANGENT SCREEN, AUTOPLOT, ARC PERIMETER, OR SINGLE STIMULUSLEVEL AUTOMATED TEST, SUCH AS OCTOPUS 3 OR 7 EQUIVALENT)

92082VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT;INTERMEDIATE EXAMINATION (EG, AT LEAST 2 ISOPTERS ON GOLDMANN PERIMETER, ORSEMIQUANTITATIVE, AUTOMATED SUPRATHRESHOLD SCREENING PROGRAM, HUMPHREYSUPRATHRESHOLD AUTOMATIC DIAGNOSTIC TEST, OCTOPUS PROGRAM 33)

92083

VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT;EXTENDED EXAMINATION (EG, GOLDMANN VISUAL FIELDS WITH AT LEAST 3 ISOPTERS PLOTTED ANDSTATIC DETERMINATION WITHIN THE CENTRAL 30 DEG;, OR QUANTITATIVE, AUTOMATED THRESHOLDPERIMETRY, OCTOPUS PROGRAM G-1, 32 OR 42, HUMPHREY VISUAL FIELD ANALYZER FULL THRESHOLDPROGRAMS 30-2, 24-2, OR 30/60-2)

ICD-10 Codes Description

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to reportthis service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, servicesreported under other Revenue Codes are equally subject to this coverage determination. Complete absence of allRevenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed toapply 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 tophysicians, other professionals and suppliers who bill these services to the Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to theFISS 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.

CPT/HCPCS CodesGroup 1 Paragraph: N/A

Group 1 Codes:

ICD-10 Codes that Support Medical NecessityGroup 1 Paragraph: The correct use of an ICD-10-CM code listed below does not assure coverage of a service.The service must be reasonable and necessary in the specific case and must meet the criteria specified in thisdetermination.

Group 1 Codes:


ICD-10 Codes DescriptionA18.53 Tuberculous chorioretinitisA52.12 Other cerebrospinal syphilisA52.14 Late syphilitic encephalitisA52.15 Late syphilitic neuropathyA52.19 Other symptomatic neurosyphilisA52.73 Symptomatic late syphilis of other respiratory organsA52.76 Other genitourinary symptomatic late syphilisA52.79 Other symptomatic late syphilisB45.1 Cerebral cryptococcosisC69.01 Malignant neoplasm of right conjunctivaC69.02 Malignant neoplasm of left conjunctivaC69.11 Malignant neoplasm of right corneaC69.12 Malignant neoplasm of left corneaC69.21 Malignant neoplasm of right retinaC69.22 Malignant neoplasm of left retinaC69.31 Malignant neoplasm of right choroidC69.32 Malignant neoplasm of left choroidC69.41 Malignant neoplasm of right ciliary bodyC69.42 Malignant neoplasm of left ciliary bodyC69.51 Malignant neoplasm of right lacrimal gland and ductC69.52 Malignant neoplasm of left lacrimal gland and ductC69.61 Malignant neoplasm of right orbitC69.62 Malignant neoplasm of left orbitC69.80 Malignant neoplasm of overlapping sites of unspecified eye and adnexaC69.81 Malignant neoplasm of overlapping sites of right eye and adnexaC69.82 Malignant neoplasm of overlapping sites of left eye and adnexaC69.91 Malignant neoplasm of unspecified site of right eyeC69.92 Malignant neoplasm of unspecified site of left eyeC70.0 Malignant neoplasm of cerebral meningesC71.0 Malignant neoplasm of cerebrum, except lobes and ventriclesC71.1 Malignant neoplasm of frontal lobeC71.2 Malignant neoplasm of temporal lobeC71.3 Malignant neoplasm of parietal lobeC71.4 Malignant neoplasm of occipital lobeC71.5 Malignant neoplasm of cerebral ventricleC71.6 Malignant neoplasm of cerebellumC71.7 Malignant neoplasm of brain stemC71.8 Malignant neoplasm of overlapping sites of brainC71.9 Malignant neoplasm of brain, unspecifiedC72.21 Malignant neoplasm of right olfactory nerveC72.22 Malignant neoplasm of left olfactory nerveC72.31 Malignant neoplasm of right optic nerveC72.32 Malignant neoplasm of left optic nerveC72.41 Malignant neoplasm of right acoustic nerveC72.42 Malignant neoplasm of left acoustic nerveC72.59 Malignant neoplasm of other cranial nervesC75.1 Malignant neoplasm of pituitary glandC75.2 Malignant neoplasm of craniopharyngeal ductC75.3 Malignant neoplasm of pineal glandC79.32 Secondary malignant neoplasm of cerebral meningesC79.49 Secondary malignant neoplasm of other parts of nervous systemD09.21 Carcinoma in situ of right eyeD09.22 Carcinoma in situ of left eyeD18.02 Hemangioma of intracranial structuresD18.09 Hemangioma of other sitesD31.01 Benign neoplasm of right conjunctivaD31.02 Benign neoplasm of left conjunctivaD31.11 Benign neoplasm of right cornea


ICD-10 Codes DescriptionD31.12 Benign neoplasm of left corneaD31.21 Benign neoplasm of right retinaD31.22 Benign neoplasm of left retinaD31.31 Benign neoplasm of right choroidD31.32 Benign neoplasm of left choroidD31.41 Benign neoplasm of right ciliary bodyD31.42 Benign neoplasm of left ciliary bodyD31.50 Benign neoplasm of unspecified lacrimal gland and ductD31.51 Benign neoplasm of right lacrimal gland and ductD31.52 Benign neoplasm of left lacrimal gland and ductD31.61 Benign neoplasm of unspecified site of right orbitD31.62 Benign neoplasm of unspecified site of left orbitD31.91 Benign neoplasm of unspecified part of right eyeD31.92 Benign neoplasm of unspecified part of left eyeD32.0 Benign neoplasm of cerebral meningesD33.0 Benign neoplasm of brain, supratentorialD33.1 Benign neoplasm of brain, infratentorialD33.3 Benign neoplasm of cranial nervesD35.2 Benign neoplasm of pituitary glandD35.3 Benign neoplasm of craniopharyngeal ductD35.4 Benign neoplasm of pineal glandD42.0 Neoplasm of uncertain behavior of cerebral meningesD42.1 Neoplasm of uncertain behavior of spinal meningesD44.3 Neoplasm of uncertain behavior of pituitary glandD44.4 Neoplasm of uncertain behavior of craniopharyngeal ductD44.5 Neoplasm of uncertain behavior of pineal glandD49.7 Neoplasm of unspecified behavior of endocrine glands and other parts of nervous systemD49.81 Neoplasm of unspecified behavior of retina and choroidD49.89 Neoplasm of unspecified behavior of other specified sitesE05.00 Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or stormE05.01 Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or stormE05.10 Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or stormE05.11 Thyrotoxicosis with toxic single thyroid nodule with thyrotoxic crisis or storm

E08.311 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macularedema

E08.319 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy withoutmacular edema

E08.321 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathywith macular edema

E08.329 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathywithout macular edema

E08.331 Diabetes mellitus due to underlying condition with moderate nonproliferative diabeticretinopathy with macular edema

E08.339 Diabetes mellitus due to underlying condition with moderate nonproliferative diabeticretinopathy without macular edema

E08.341 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathywith macular edema

E08.349 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathywithout macular edema

E08.351 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy withmacular edema

E09.321 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy withmacular edema

E09.329 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathywithout macular edema

E09.331 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathywith macular edema

E09.339 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathywithout macular edema

E09.341


ICD-10 Codes DescriptionDrug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathywith macular edema

E09.349 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathywithout macular edema

E09.351 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macularedema

E10.311 Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edemaE10.319 Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edemaE10.321 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edemaE10.329 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema

E10.331 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macularedema

E10.339 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macularedema

E10.341 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema

E10.349 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macularedema

E10.351 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edemaE10.359 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edemaE10.36 Type 1 diabetes mellitus with diabetic cataractE10.39 Type 1 diabetes mellitus with other diabetic ophthalmic complicationE11.311 Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edemaE11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edemaE11.321 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edemaE11.329 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema

E11.331 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macularedema

E11.339 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macularedema

E11.341 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema

E11.349 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macularedema

E11.351 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edemaE11.359 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edemaE11.36 Type 2 diabetes mellitus with diabetic cataractE11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complicationE13.311 Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edemaE13.319 Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema

E13.321 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macularedema

E13.329 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macularedema

E13.331 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy withmacular edema

E13.339 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy withoutmacular edema

E13.341 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macularedema

E13.349 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy withoutmacular edema

E13.351 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edemaE13.359 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edemaE13.36 Other specified diabetes mellitus with diabetic cataractE13.39 Other specified diabetes mellitus with other diabetic ophthalmic complicationE22.0 Acromegaly and pituitary gigantismE22.1 HyperprolactinemiaE22.2 Syndrome of inappropriate secretion of antidiuretic hormoneE22.8 Other hyperfunction of pituitary glandE22.9 Hyperfunction of pituitary gland, unspecifiedE23.0 Hypopituitarism


ICD-10 Codes DescriptionE23.1 Drug-induced hypopituitarismE23.2 Diabetes insipidusE23.3 Hypothalamic dysfunction, not elsewhere classifiedE23.6 Other disorders of pituitary glandE23.7 Disorder of pituitary gland, unspecifiedE24.1 Nelson's syndromeE34.1 Other hypersecretion of intestinal hormonesE34.4 Constitutional tall statureE34.8 Other specified endocrine disordersE35 Disorders of endocrine glands in diseases classified elsewhereE50.0 Vitamin A deficiency with conjunctival xerosisE50.1 Vitamin A deficiency with Bitot's spot and conjunctival xerosisE50.2 Vitamin A deficiency with corneal xerosisE50.3 Vitamin A deficiency with corneal ulceration and xerosisE50.4 Vitamin A deficiency with keratomalaciaE50.5 Vitamin A deficiency with night blindnessE50.6 Vitamin A deficiency with xerophthalmic scars of corneaE50.7 Other ocular manifestations of vitamin A deficiencyE50.8 Other manifestations of vitamin A deficiencyE50.9 Vitamin A deficiency, unspecifiedE64.1 Sequelae of vitamin A deficiencyE89.3 Postprocedural hypopituitarismF07.81 Postconcussional syndromeF41.9 Anxiety disorder, unspecifiedF44.4 Conversion disorder with motor symptom or deficitF44.5 Conversion disorder with seizures or convulsionsF44.6 Conversion disorder with sensory symptom or deficitF44.7 Conversion disorder with mixed symptom presentationG00.0 Hemophilus meningitisG00.1 Pneumococcal meningitisG00.2 Streptococcal meningitisG00.3 Staphylococcal meningitisG00.8 Other bacterial meningitisG00.9 Bacterial meningitis, unspecifiedG01 Meningitis in bacterial diseases classified elsewhereG02 Meningitis in other infectious and parasitic diseases classified elsewhereG03.0 Nonpyogenic meningitisG03.1 Chronic meningitisG03.8 Meningitis due to other specified causesG03.9 Meningitis, unspecifiedG04.00 Acute disseminated encephalitis and encephalomyelitis, unspecifiedG04.01 Postinfectious acute disseminated encephalitis and encephalomyelitis (postinfectious ADEM)G04.02 Postimmunization acute disseminated encephalitis, myelitis and encephalomyelitisG04.2 Bacterial meningoencephalitis and meningomyelitis, not elsewhere classifiedG04.30 Acute necrotizing hemorrhagic encephalopathy, unspecifiedG04.31 Postinfectious acute necrotizing hemorrhagic encephalopathyG04.32 Postimmunization acute necrotizing hemorrhagic encephalopathyG04.39 Other acute necrotizing hemorrhagic encephalopathyG04.81 Other encephalitis and encephalomyelitisG04.89 Other myelitisG04.90 Encephalitis and encephalomyelitis, unspecifiedG04.91 Myelitis, unspecifiedG05.3 Encephalitis and encephalomyelitis in diseases classified elsewhereG05.4 Myelitis in diseases classified elsewhereG06.0 Intracranial abscess and granulomaG24.5 BlepharospasmG35 Multiple sclerosisG36.0 Neuromyelitis optica [Devic]


ICD-10 Codes DescriptionG36.1 Acute and subacute hemorrhagic leukoencephalitis [Hurst]G36.8 Other specified acute disseminated demyelinationG36.9 Acute disseminated demyelination, unspecifiedG37.0 Diffuse sclerosis of central nervous systemG37.1 Central demyelination of corpus callosumG37.2 Central pontine myelinolysisG37.3 Acute transverse myelitis in demyelinating disease of central nervous systemG37.4 Subacute necrotizing myelitis of central nervous systemG37.5 Concentric sclerosis [Balo] of central nervous systemG37.8 Other specified demyelinating diseases of central nervous systemG37.9 Demyelinating disease of central nervous system, unspecified

G40.001 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures oflocalized onset, not intractable, with status epilepticus

G40.009 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures oflocalized onset, not intractable, without status epilepticus

G40.011 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures oflocalized onset, intractable, with status epilepticus

G40.019 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures oflocalized onset, intractable, without status epilepticus

G40.101 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simplepartial seizures, not intractable, with status epilepticus

G40.109 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simplepartial seizures, not intractable, without status epilepticus

G40.111 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simplepartial seizures, intractable, with status epilepticus

G40.119 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simplepartial seizures, intractable, without status epilepticus

G40.201 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes withcomplex partial seizures, not intractable, with status epilepticus

G40.209 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes withcomplex partial seizures, not intractable, without status epilepticus

G40.211 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes withcomplex partial seizures, intractable, with status epilepticus

G40.219 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes withcomplex partial seizures, intractable, without status epilepticus

G40.301 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus

G40.309 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without statusepilepticus

G40.311 Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticusG40.319 Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticusG40.A01 Absence epileptic syndrome, not intractable, with status epilepticusG40.A09 Absence epileptic syndrome, not intractable, without status epilepticusG40.A11 Absence epileptic syndrome, intractable, with status epilepticusG40.A19 Absence epileptic syndrome, intractable, without status epilepticusG40.B01 Juvenile myoclonic epilepsy, not intractable, with status epilepticusG40.B09 Juvenile myoclonic epilepsy, not intractable, without status epilepticusG40.B11 Juvenile myoclonic epilepsy, intractable, with status epilepticusG40.B19 Juvenile myoclonic epilepsy, intractable, without status epilepticusG40.401 Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticusG40.409 Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticusG40.411 Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticusG40.419 Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticusG40.501 Epileptic seizures related to external causes, not intractable, with status epilepticusG40.509 Epileptic seizures related to external causes, not intractable, without status epilepticusG40.801 Other epilepsy, not intractable, with status epilepticusG40.802 Other epilepsy, not intractable, without status epilepticusG40.803 Other epilepsy, intractable, with status epilepticusG40.804 Other epilepsy, intractable, without status epilepticusG40.811 Lennox-Gastaut syndrome, not intractable, with status epilepticusG40.812 Lennox-Gastaut syndrome, not intractable, without status epilepticus


ICD-10 Codes DescriptionG40.813 Lennox-Gastaut syndrome, intractable, with status epilepticusG40.814 Lennox-Gastaut syndrome, intractable, without status epilepticusG40.821 Epileptic spasms, not intractable, with status epilepticusG40.822 Epileptic spasms, not intractable, without status epilepticusG40.823 Epileptic spasms, intractable, with status epilepticusG40.824 Epileptic spasms, intractable, without status epilepticusG40.89 Other seizuresG40.901 Epilepsy, unspecified, not intractable, with status epilepticusG40.909 Epilepsy, unspecified, not intractable, without status epilepticusG40.911 Epilepsy, unspecified, intractable, with status epilepticusG40.919 Epilepsy, unspecified, intractable, without status epilepticusG43.109 Migraine with aura, not intractable, without status migrainosusG43.119 Migraine with aura, intractable, without status migrainosusG43.B0 Ophthalmoplegic migraine, not intractableG43.B1 Ophthalmoplegic migraine, intractableG43.C0 Periodic headache syndromes in child or adult, not intractableG43.C1 Periodic headache syndromes in child or adult, intractableG43.809 Other migraine, not intractable, without status migrainosusG43.819 Other migraine, intractable, without status migrainosusG43.909 Migraine, unspecified, not intractable, without status migrainosusG43.919 Migraine, unspecified, intractable, without status migrainosusG44.1 Vascular headache, not elsewhere classifiedG45.0 Vertebro-basilar artery syndromeG45.3 Amaurosis fugaxG45.4 Transient global amnesiaG45.9 Transient cerebral ischemic attack, unspecifiedG46.3 Brain stem stroke syndromeG46.4 Cerebellar stroke syndromeG46.5 Pure motor lacunar syndromeG46.6 Pure sensory lacunar syndromeG46.7 Other lacunar syndromesG46.8 Other vascular syndromes of brain in cerebrovascular diseasesG80.2 Spastic hemiplegic cerebral palsyG81.00 Flaccid hemiplegia affecting unspecified sideG81.01 Flaccid hemiplegia affecting right dominant sideG81.02 Flaccid hemiplegia affecting left dominant sideG81.03 Flaccid hemiplegia affecting right nondominant sideG81.04 Flaccid hemiplegia affecting left nondominant sideG81.11 Spastic hemiplegia affecting right dominant sideG81.12 Spastic hemiplegia affecting left dominant sideG81.13 Spastic hemiplegia affecting right nondominant sideG81.14 Spastic hemiplegia affecting left nondominant sideG81.90 Hemiplegia, unspecified affecting unspecified sideG81.91 Hemiplegia, unspecified affecting right dominant sideG81.92 Hemiplegia, unspecified affecting left dominant sideG81.93 Hemiplegia, unspecified affecting right nondominant sideG81.94 Hemiplegia, unspecified affecting left nondominant sideG91.2 (Idiopathic) normal pressure hydrocephalusG92 Toxic encephalopathyG93.2 Benign intracranial hypertensionG93.40 Encephalopathy, unspecifiedG93.41 Metabolic encephalopathyG93.49 Other encephalopathyG93.5 Compression of brainH01.8 Other specified inflammations of eyelidH01.9 Unspecified inflammation of eyelidH02.31 Blepharochalasis right upper eyelidH02.32 Blepharochalasis right lower eyelid


ICD-10 Codes DescriptionH02.34 Blepharochalasis left upper eyelidH02.35 Blepharochalasis left lower eyelidH02.401 Unspecified ptosis of right eyelidH02.402 Unspecified ptosis of left eyelidH02.403 Unspecified ptosis of bilateral eyelidsH02.411 Mechanical ptosis of right eyelidH02.412 Mechanical ptosis of left eyelidH02.413 Mechanical ptosis of bilateral eyelidsH02.421 Myogenic ptosis of right eyelidH02.422 Myogenic ptosis of left eyelidH02.423 Myogenic ptosis of bilateral eyelidsH02.431 Paralytic ptosis of right eyelidH02.432 Paralytic ptosis of left eyelidH02.433 Paralytic ptosis of bilateral eyelidsH02.831 Dermatochalasis of right upper eyelidH02.832 Dermatochalasis of right lower eyelidH02.834 Dermatochalasis of left upper eyelidH02.835 Dermatochalasis of left lower eyelidH05.00 Unspecified acute inflammation of orbitH05.011 Cellulitis of right orbitH05.012 Cellulitis of left orbitH05.013 Cellulitis of bilateral orbitsH05.021 Osteomyelitis of right orbitH05.022 Osteomyelitis of left orbitH05.023 Osteomyelitis of bilateral orbitsH05.031 Periostitis of right orbitH05.032 Periostitis of left orbitH05.033 Periostitis of bilateral orbitsH05.041 Tenonitis of right orbitH05.042 Tenonitis of left orbitH05.043 Tenonitis of bilateral orbitsH05.111 Granuloma of right orbitH05.112 Granuloma of left orbitH05.113 Granuloma of bilateral orbitsH05.20 Unspecified exophthalmosH05.211 Displacement (lateral) of globe, right eyeH05.212 Displacement (lateral) of globe, left eyeH05.213 Displacement (lateral) of globe, bilateralH05.221 Edema of right orbitH05.222 Edema of left orbitH05.223 Edema of bilateral orbitH05.231 Hemorrhage of right orbitH05.232 Hemorrhage of left orbitH05.233 Hemorrhage of bilateral orbitH05.241 Constant exophthalmos, right eyeH05.242 Constant exophthalmos, left eyeH05.243 Constant exophthalmos, bilateralH05.251 Intermittent exophthalmos, right eyeH05.252 Intermittent exophthalmos, left eyeH05.253 Intermittent exophthalmos, bilateralH05.261 Pulsating exophthalmos, right eyeH05.262 Pulsating exophthalmos, left eyeH05.263 Pulsating exophthalmos, bilateralH05.30 Unspecified deformity of orbitH05.311 Atrophy of right orbitH05.312 Atrophy of left orbitH05.313 Atrophy of bilateral orbitH05.321 Deformity of right orbit due to bone disease


ICD-10 Codes DescriptionH05.322 Deformity of left orbit due to bone diseaseH05.323 Deformity of bilateral orbits due to bone diseaseH05.331 Deformity of right orbit due to trauma or surgeryH05.332 Deformity of left orbit due to trauma or surgeryH05.333 Deformity of bilateral orbits due to trauma or surgeryH05.341 Enlargement of right orbitH05.342 Enlargement of left orbitH05.343 Enlargement of bilateral orbitsH05.351 Exostosis of right orbitH05.352 Exostosis of left orbitH05.353 Exostosis of bilateral orbitsH05.401 Unspecified enophthalmos, right eyeH05.402 Unspecified enophthalmos, left eyeH05.403 Unspecified enophthalmos, bilateralH05.411 Enophthalmos due to atrophy of orbital tissue, right eyeH05.412 Enophthalmos due to atrophy of orbital tissue, left eyeH05.413 Enophthalmos due to atrophy of orbital tissue, bilateralH05.421 Enophthalmos due to trauma or surgery, right eyeH05.422 Enophthalmos due to trauma or surgery, left eyeH05.423 Enophthalmos due to trauma or surgery, bilateralH05.429 Enophthalmos due to trauma or surgery, unspecified eyeH05.51 Retained (old) foreign body following penetrating wound of right orbitH05.52 Retained (old) foreign body following penetrating wound of left orbitH05.53 Retained (old) foreign body following penetrating wound of bilateral orbitsH05.811 Cyst of right orbitH05.812 Cyst of left orbitH05.813 Cyst of bilateral orbitsH05.821 Myopathy of extraocular muscles, right orbitH05.822 Myopathy of extraocular muscles, left orbitH05.823 Myopathy of extraocular muscles, bilateralH05.89 Other disorders of orbitH05.9 Unspecified disorder of orbitH30.001 Unspecified focal chorioretinal inflammation, right eyeH30.002 Unspecified focal chorioretinal inflammation, left eyeH30.003 Unspecified focal chorioretinal inflammation, bilateralH30.011 Focal chorioretinal inflammation, juxtapapillary, right eyeH30.012 Focal chorioretinal inflammation, juxtapapillary, left eyeH30.013 Focal chorioretinal inflammation, juxtapapillary, bilateralH30.019 Focal chorioretinal inflammation, juxtapapillary, unspecified eyeH30.021 Focal chorioretinal inflammation of posterior pole, right eyeH30.022 Focal chorioretinal inflammation of posterior pole, left eyeH30.023 Focal chorioretinal inflammation of posterior pole, bilateralH30.029 Focal chorioretinal inflammation of posterior pole, unspecified eyeH30.031 Focal chorioretinal inflammation, peripheral, right eyeH30.032 Focal chorioretinal inflammation, peripheral, left eyeH30.033 Focal chorioretinal inflammation, peripheral, bilateralH30.039 Focal chorioretinal inflammation, peripheral, unspecified eyeH30.041 Focal chorioretinal inflammation, macular or paramacular, right eyeH30.042 Focal chorioretinal inflammation, macular or paramacular, left eyeH30.043 Focal chorioretinal inflammation, macular or paramacular, bilateralH30.101 Unspecified disseminated chorioretinal inflammation, right eyeH30.102 Unspecified disseminated chorioretinal inflammation, left eyeH30.103 Unspecified disseminated chorioretinal inflammation, bilateralH30.109 Unspecified disseminated chorioretinal inflammation, unspecified eyeH30.111 Disseminated chorioretinal inflammation of posterior pole, right eyeH30.112 Disseminated chorioretinal inflammation of posterior pole, left eyeH30.113 Disseminated chorioretinal inflammation of posterior pole, bilateralH30.121 Disseminated chorioretinal inflammation, peripheral right eye


ICD-10 Codes DescriptionH30.122 Disseminated chorioretinal inflammation, peripheral, left eyeH30.123 Disseminated chorioretinal inflammation, peripheral, bilateralH30.131 Disseminated chorioretinal inflammation, generalized, right eyeH30.132 Disseminated chorioretinal inflammation, generalized, left eyeH30.133 Disseminated chorioretinal inflammation, generalized, bilateralH30.141 Acute posterior multifocal placoid pigment epitheliopathy, right eyeH30.142 Acute posterior multifocal placoid pigment epitheliopathy, left eyeH30.143 Acute posterior multifocal placoid pigment epitheliopathy, bilateralH30.21 Posterior cyclitis, right eyeH30.22 Posterior cyclitis, left eyeH30.23 Posterior cyclitis, bilateralH30.811 Harada's disease, right eyeH30.812 Harada's disease, left eyeH30.813 Harada's disease, bilateralH30.891 Other chorioretinal inflammations, right eyeH30.892 Other chorioretinal inflammations, left eyeH30.893 Other chorioretinal inflammations, bilateralH30.91 Unspecified chorioretinal inflammation, right eyeH30.92 Unspecified chorioretinal inflammation, left eyeH30.93 Unspecified chorioretinal inflammation, bilateralH31.101 Choroidal degeneration, unspecified, right eyeH31.102 Choroidal degeneration, unspecified, left eyeH31.103 Choroidal degeneration, unspecified, bilateralH31.111 Age-related choroidal atrophy, right eyeH31.112 Age-related choroidal atrophy, left eyeH31.113 Age-related choroidal atrophy, bilateralH31.121 Diffuse secondary atrophy of choroid, right eyeH31.122 Diffuse secondary atrophy of choroid, left eyeH31.123 Diffuse secondary atrophy of choroid, bilateralH31.20 Hereditary choroidal dystrophy, unspecifiedH31.21 ChoroideremiaH31.22 Choroidal dystrophy (central areolar) (generalized) (peripapillary)H31.23 Gyrate atrophy, choroidH31.29 Other hereditary choroidal dystrophyH31.301 Unspecified choroidal hemorrhage, right eyeH31.302 Unspecified choroidal hemorrhage, left eyeH31.303 Unspecified choroidal hemorrhage, bilateralH31.311 Expulsive choroidal hemorrhage, right eyeH31.312 Expulsive choroidal hemorrhage, left eyeH31.313 Expulsive choroidal hemorrhage, bilateralH31.321 Choroidal rupture, right eyeH31.322 Choroidal rupture, left eyeH31.323 Choroidal rupture, bilateralH31.401 Unspecified choroidal detachment, right eyeH31.402 Unspecified choroidal detachment, left eyeH31.403 Unspecified choroidal detachment, bilateralH31.411 Hemorrhagic choroidal detachment, right eyeH31.412 Hemorrhagic choroidal detachment, left eyeH31.413 Hemorrhagic choroidal detachment, bilateralH31.421 Serous choroidal detachment, right eyeH31.422 Serous choroidal detachment, left eyeH31.423 Serous choroidal detachment, bilateralH31.8 Other specified disorders of choroidH31.9 Unspecified disorder of choroidH32 Chorioretinal disorders in diseases classified elsewhereH33.001 Unspecified retinal detachment with retinal break, right eyeH33.002 Unspecified retinal detachment with retinal break, left eyeH33.003 Unspecified retinal detachment with retinal break, bilateral


ICD-10 Codes DescriptionH33.011 Retinal detachment with single break, right eyeH33.012 Retinal detachment with single break, left eyeH33.013 Retinal detachment with single break, bilateralH33.021 Retinal detachment with multiple breaks, right eyeH33.022 Retinal detachment with multiple breaks, left eyeH33.023 Retinal detachment with multiple breaks, bilateralH33.031 Retinal detachment with giant retinal tear, right eyeH33.032 Retinal detachment with giant retinal tear, left eyeH33.033 Retinal detachment with giant retinal tear, bilateralH33.041 Retinal detachment with retinal dialysis, right eyeH33.042 Retinal detachment with retinal dialysis, left eyeH33.043 Retinal detachment with retinal dialysis, bilateralH33.051 Total retinal detachment, right eyeH33.052 Total retinal detachment, left eyeH33.053 Total retinal detachment, bilateralH33.059 Total retinal detachment, unspecified eyeH33.101 Unspecified retinoschisis, right eyeH33.102 Unspecified retinoschisis, left eyeH33.103 Unspecified retinoschisis, bilateralH33.111 Cyst of ora serrata, right eyeH33.112 Cyst of ora serrata, left eyeH33.113 Cyst of ora serrata, bilateralH33.191 Other retinoschisis and retinal cysts, right eyeH33.192 Other retinoschisis and retinal cysts, left eyeH33.193 Other retinoschisis and retinal cysts, bilateralH33.21 Serous retinal detachment, right eyeH33.22 Serous retinal detachment, left eyeH33.23 Serous retinal detachment, bilateralH33.301 Unspecified retinal break, right eyeH33.302 Unspecified retinal break, left eyeH33.303 Unspecified retinal break, bilateralH33.311 Horseshoe tear of retina without detachment, right eyeH33.312 Horseshoe tear of retina without detachment, left eyeH33.313 Horseshoe tear of retina without detachment, bilateralH33.319 Horseshoe tear of retina without detachment, unspecified eyeH33.321 Round hole, right eyeH33.322 Round hole, left eyeH33.323 Round hole, bilateralH33.331 Multiple defects of retina without detachment, right eyeH33.332 Multiple defects of retina without detachment, left eyeH33.333 Multiple defects of retina without detachment, bilateralH33.41 Traction detachment of retina, right eyeH33.42 Traction detachment of retina, left eyeH33.43 Traction detachment of retina, bilateralH33.8 Other retinal detachmentsH34.01 Transient retinal artery occlusion, right eyeH34.02 Transient retinal artery occlusion, left eyeH34.03 Transient retinal artery occlusion, bilateralH34.11 Central retinal artery occlusion, right eyeH34.12 Central retinal artery occlusion, left eyeH34.13 Central retinal artery occlusion, bilateralH34.211 Partial retinal artery occlusion, right eyeH34.212 Partial retinal artery occlusion, left eyeH34.213 Partial retinal artery occlusion, bilateralH34.231 Retinal artery branch occlusion, right eyeH34.232 Retinal artery branch occlusion, left eyeH34.233 Retinal artery branch occlusion, bilateralH34.811 Central retinal vein occlusion, right eye


ICD-10 Codes DescriptionH34.812 Central retinal vein occlusion, left eyeH34.813 Central retinal vein occlusion, bilateralH34.821 Venous engorgement, right eyeH34.822 Venous engorgement, left eyeH34.823 Venous engorgement, bilateralH34.831 Tributary (branch) retinal vein occlusion, right eyeH34.832 Tributary (branch) retinal vein occlusion, left eyeH34.833 Tributary (branch) retinal vein occlusion, bilateralH34.9 Unspecified retinal vascular occlusionH35.011 Changes in retinal vascular appearance, right eyeH35.012 Changes in retinal vascular appearance, left eyeH35.013 Changes in retinal vascular appearance, bilateralH35.021 Exudative retinopathy, right eyeH35.022 Exudative retinopathy, left eyeH35.023 Exudative retinopathy, bilateralH35.031 Hypertensive retinopathy, right eyeH35.032 Hypertensive retinopathy, left eyeH35.033 Hypertensive retinopathy, bilateralH35.041 Retinal micro-aneurysms, unspecified, right eyeH35.042 Retinal micro-aneurysms, unspecified, left eyeH35.043 Retinal micro-aneurysms, unspecified, bilateralH35.051 Retinal neovascularization, unspecified, right eyeH35.052 Retinal neovascularization, unspecified, left eyeH35.053 Retinal neovascularization, unspecified, bilateralH35.061 Retinal vasculitis, right eyeH35.062 Retinal vasculitis, left eyeH35.063 Retinal vasculitis, bilateralH35.071 Retinal telangiectasis, right eyeH35.072 Retinal telangiectasis, left eyeH35.073 Retinal telangiectasis, bilateralH35.09 Other intraretinal microvascular abnormalitiesH35.171 Retrolental fibroplasia, right eyeH35.172 Retrolental fibroplasia, left eyeH35.173 Retrolental fibroplasia, bilateralH35.30 Unspecified macular degenerationH35.31 Nonexudative age-related macular degenerationH35.32 Exudative age-related macular degenerationH35.33 Angioid streaks of maculaH35.341 Macular cyst, hole, or pseudohole, right eyeH35.342 Macular cyst, hole, or pseudohole, left eyeH35.343 Macular cyst, hole, or pseudohole, bilateralH35.351 Cystoid macular degeneration, right eyeH35.352 Cystoid macular degeneration, left eyeH35.353 Cystoid macular degeneration, bilateralH35.361 Drusen (degenerative) of macula, right eyeH35.362 Drusen (degenerative) of macula, left eyeH35.363 Drusen (degenerative) of macula, bilateralH35.371 Puckering of macula, right eyeH35.372 Puckering of macula, left eyeH35.373 Puckering of macula, bilateralH35.381 Toxic maculopathy, right eyeH35.382 Toxic maculopathy, left eyeH35.383 Toxic maculopathy, bilateralH35.40 Unspecified peripheral retinal degenerationH35.411 Lattice degeneration of retina, right eyeH35.412 Lattice degeneration of retina, left eyeH35.413 Lattice degeneration of retina, bilateralH35.421 Microcystoid degeneration of retina, right eye


ICD-10 Codes DescriptionH35.422 Microcystoid degeneration of retina, left eyeH35.423 Microcystoid degeneration of retina, bilateralH35.431 Paving stone degeneration of retina, right eyeH35.432 Paving stone degeneration of retina, left eyeH35.433 Paving stone degeneration of retina, bilateralH35.441 Age-related reticular degeneration of retina, right eyeH35.442 Age-related reticular degeneration of retina, left eyeH35.443 Age-related reticular degeneration of retina, bilateralH35.451 Secondary pigmentary degeneration, right eyeH35.452 Secondary pigmentary degeneration, left eyeH35.453 Secondary pigmentary degeneration, bilateralH35.461 Secondary vitreoretinal degeneration, right eyeH35.462 Secondary vitreoretinal degeneration, left eyeH35.463 Secondary vitreoretinal degeneration, bilateralH35.50 Unspecified hereditary retinal dystrophyH35.51 Vitreoretinal dystrophyH35.52 Pigmentary retinal dystrophyH35.53 Other dystrophies primarily involving the sensory retinaH35.54 Dystrophies primarily involving the retinal pigment epitheliumH35.61 Retinal hemorrhage, right eyeH35.62 Retinal hemorrhage, left eyeH35.63 Retinal hemorrhage, bilateralH35.70 Unspecified separation of retinal layersH35.711 Central serous chorioretinopathy, right eyeH35.712 Central serous chorioretinopathy, left eyeH35.713 Central serous chorioretinopathy, bilateralH35.721 Serous detachment of retinal pigment epithelium, right eyeH35.722 Serous detachment of retinal pigment epithelium, left eyeH35.723 Serous detachment of retinal pigment epithelium, bilateralH35.731 Hemorrhagic detachment of retinal pigment epithelium, right eyeH35.732 Hemorrhagic detachment of retinal pigment epithelium, left eyeH35.733 Hemorrhagic detachment of retinal pigment epithelium, bilateralH35.81 Retinal edemaH35.82 Retinal ischemiaH35.89 Other specified retinal disordersH35.9 Unspecified retinal disorderH36 Retinal disorders in diseases classified elsewhereH40.001 Preglaucoma, unspecified, right eyeH40.002 Preglaucoma, unspecified, left eyeH40.003 Preglaucoma, unspecified, bilateralH40.011 Open angle with borderline findings, low risk, right eyeH40.012 Open angle with borderline findings, low risk, left eyeH40.013 Open angle with borderline findings, low risk, bilateralH40.021 Open angle with borderline findings, high risk, right eyeH40.022 Open angle with borderline findings, high risk, left eyeH40.023 Open angle with borderline findings, high risk, bilateralH40.031 Anatomical narrow angle, right eyeH40.032 Anatomical narrow angle, left eyeH40.033 Anatomical narrow angle, bilateralH40.041 Steroid responder, right eyeH40.042 Steroid responder, left eyeH40.043 Steroid responder, bilateralH40.051 Ocular hypertension, right eyeH40.052 Ocular hypertension, left eyeH40.053 Ocular hypertension, bilateralH40.061 Primary angle closure without glaucoma damage, right eyeH40.062 Primary angle closure without glaucoma damage, left eyeH40.063 Primary angle closure without glaucoma damage, bilateral


ICD-10 Codes DescriptionH40.10X0 Unspecified open-angle glaucoma, stage unspecifiedH40.10X1 Unspecified open-angle glaucoma, mild stageH40.10X2 Unspecified open-angle glaucoma, moderate stageH40.10X3 Unspecified open-angle glaucoma, severe stageH40.10X4 Unspecified open-angle glaucoma, indeterminate stageH40.11X0 Primary open-angle glaucoma, stage unspecifiedH40.11X1 Primary open-angle glaucoma, mild stageH40.11X2 Primary open-angle glaucoma, moderate stageH40.11X3 Primary open-angle glaucoma, severe stageH40.11X4 Primary open-angle glaucoma, indeterminate stageH40.1210 Low-tension glaucoma, right eye, stage unspecifiedH40.1211 Low-tension glaucoma, right eye, mild stageH40.1212 Low-tension glaucoma, right eye, moderate stageH40.1213 Low-tension glaucoma, right eye, severe stageH40.1214 Low-tension glaucoma, right eye, indeterminate stageH40.1220 Low-tension glaucoma, left eye, stage unspecifiedH40.1221 Low-tension glaucoma, left eye, mild stageH40.1222 Low-tension glaucoma, left eye, moderate stageH40.1223 Low-tension glaucoma, left eye, severe stageH40.1224 Low-tension glaucoma, left eye, indeterminate stageH40.1230 Low-tension glaucoma, bilateral, stage unspecifiedH40.1231 Low-tension glaucoma, bilateral, mild stageH40.1232 Low-tension glaucoma, bilateral, moderate stageH40.1233 Low-tension glaucoma, bilateral, severe stageH40.1234 Low-tension glaucoma, bilateral, indeterminate stageH40.1310 Pigmentary glaucoma, right eye, stage unspecifiedH40.1311 Pigmentary glaucoma, right eye, mild stageH40.1312 Pigmentary glaucoma, right eye, moderate stageH40.1313 Pigmentary glaucoma, right eye, severe stageH40.1314 Pigmentary glaucoma, right eye, indeterminate stageH40.1320 Pigmentary glaucoma, left eye, stage unspecifiedH40.1321 Pigmentary glaucoma, left eye, mild stageH40.1322 Pigmentary glaucoma, left eye, moderate stageH40.1323 Pigmentary glaucoma, left eye, severe stageH40.1324 Pigmentary glaucoma, left eye, indeterminate stageH40.1330 Pigmentary glaucoma, bilateral, stage unspecifiedH40.1331 Pigmentary glaucoma, bilateral, mild stageH40.1332 Pigmentary glaucoma, bilateral, moderate stageH40.1333 Pigmentary glaucoma, bilateral, severe stageH40.1334 Pigmentary glaucoma, bilateral, indeterminate stageH40.1410 Capsular glaucoma with pseudoexfoliation of lens, right eye, stage unspecifiedH40.1411 Capsular glaucoma with pseudoexfoliation of lens, right eye, mild stageH40.1412 Capsular glaucoma with pseudoexfoliation of lens, right eye, moderate stageH40.1413 Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stageH40.1414 Capsular glaucoma with pseudoexfoliation of lens, right eye, indeterminate stageH40.1420 Capsular glaucoma with pseudoexfoliation of lens, left eye, stage unspecifiedH40.1421 Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stageH40.1422 Capsular glaucoma with pseudoexfoliation of lens, left eye, moderate stageH40.1423 Capsular glaucoma with pseudoexfoliation of lens, left eye, severe stageH40.1424 Capsular glaucoma with pseudoexfoliation of lens, left eye, indeterminate stageH40.1430 Capsular glaucoma with pseudoexfoliation of lens, bilateral, stage unspecifiedH40.1431 Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stageH40.1432 Capsular glaucoma with pseudoexfoliation of lens, bilateral, moderate stageH40.1433 Capsular glaucoma with pseudoexfoliation of lens, bilateral, severe stageH40.1434 Capsular glaucoma with pseudoexfoliation of lens, bilateral, indeterminate stageH40.151 Residual stage of open-angle glaucoma, right eyeH40.152 Residual stage of open-angle glaucoma, left eyeH40.153 Residual stage of open-angle glaucoma, bilateral


ICD-10 Codes DescriptionH40.20X0 Unspecified primary angle-closure glaucoma, stage unspecifiedH40.20X1 Unspecified primary angle-closure glaucoma, mild stageH40.20X2 Unspecified primary angle-closure glaucoma, moderate stageH40.20X3 Unspecified primary angle-closure glaucoma, severe stageH40.20X4 Unspecified primary angle-closure glaucoma, indeterminate stageH40.211 Acute angle-closure glaucoma, right eyeH40.212 Acute angle-closure glaucoma, left eyeH40.213 Acute angle-closure glaucoma, bilateralH40.2210 Chronic angle-closure glaucoma, right eye, stage unspecifiedH40.2211 Chronic angle-closure glaucoma, right eye, mild stageH40.2212 Chronic angle-closure glaucoma, right eye, moderate stageH40.2213 Chronic angle-closure glaucoma, right eye, severe stageH40.2214 Chronic angle-closure glaucoma, right eye, indeterminate stageH40.2220 Chronic angle-closure glaucoma, left eye, stage unspecifiedH40.2221 Chronic angle-closure glaucoma, left eye, mild stageH40.2222 Chronic angle-closure glaucoma, left eye, moderate stageH40.2223 Chronic angle-closure glaucoma, left eye, severe stageH40.2224 Chronic angle-closure glaucoma, left eye, indeterminate stageH40.2230 Chronic angle-closure glaucoma, bilateral, stage unspecifiedH40.2231 Chronic angle-closure glaucoma, bilateral, mild stageH40.2232 Chronic angle-closure glaucoma, bilateral, moderate stageH40.2233 Chronic angle-closure glaucoma, bilateral, severe stageH40.2234 Chronic angle-closure glaucoma, bilateral, indeterminate stageH40.231 Intermittent angle-closure glaucoma, right eyeH40.232 Intermittent angle-closure glaucoma, left eyeH40.233 Intermittent angle-closure glaucoma, bilateralH40.241 Residual stage of angle-closure glaucoma, right eyeH40.242 Residual stage of angle-closure glaucoma, left eyeH40.243 Residual stage of angle-closure glaucoma, bilateralH40.31X0 Glaucoma secondary to eye trauma, right eye, stage unspecifiedH40.31X1 Glaucoma secondary to eye trauma, right eye, mild stageH40.31X2 Glaucoma secondary to eye trauma, right eye, moderate stageH40.31X3 Glaucoma secondary to eye trauma, right eye, severe stageH40.31X4 Glaucoma secondary to eye trauma, right eye, indeterminate stageH40.32X0 Glaucoma secondary to eye trauma, left eye, stage unspecifiedH40.32X1 Glaucoma secondary to eye trauma, left eye, mild stageH40.32X2 Glaucoma secondary to eye trauma, left eye, moderate stageH40.32X3 Glaucoma secondary to eye trauma, left eye, severe stageH40.32X4 Glaucoma secondary to eye trauma, left eye, indeterminate stageH40.33X0 Glaucoma secondary to eye trauma, bilateral, stage unspecifiedH40.33X1 Glaucoma secondary to eye trauma, bilateral, mild stageH40.33X2 Glaucoma secondary to eye trauma, bilateral, moderate stageH40.33X3 Glaucoma secondary to eye trauma, bilateral, severe stageH40.33X4 Glaucoma secondary to eye trauma, bilateral, indeterminate stageH40.41X0 Glaucoma secondary to eye inflammation, right eye, stage unspecifiedH40.41X1 Glaucoma secondary to eye inflammation, right eye, mild stageH40.41X2 Glaucoma secondary to eye inflammation, right eye, moderate stageH40.41X3 Glaucoma secondary to eye inflammation, right eye, severe stageH40.41X4 Glaucoma secondary to eye inflammation, right eye, indeterminate stageH40.42X0 Glaucoma secondary to eye inflammation, left eye, stage unspecifiedH40.42X1 Glaucoma secondary to eye inflammation, left eye, mild stageH40.42X2 Glaucoma secondary to eye inflammation, left eye, moderate stageH40.42X3 Glaucoma secondary to eye inflammation, left eye, severe stageH40.42X4 Glaucoma secondary to eye inflammation, left eye, indeterminate stageH40.43X0 Glaucoma secondary to eye inflammation, bilateral, stage unspecifiedH40.43X1 Glaucoma secondary to eye inflammation, bilateral, mild stageH40.43X2 Glaucoma secondary to eye inflammation, bilateral, moderate stageH40.43X3 Glaucoma secondary to eye inflammation, bilateral, severe stage


ICD-10 Codes DescriptionH40.43X4 Glaucoma secondary to eye inflammation, bilateral, indeterminate stageH40.51X0 Glaucoma secondary to other eye disorders, right eye, stage unspecifiedH40.51X1 Glaucoma secondary to other eye disorders, right eye, mild stageH40.51X2 Glaucoma secondary to other eye disorders, right eye, moderate stageH40.51X3 Glaucoma secondary to other eye disorders, right eye, severe stageH40.51X4 Glaucoma secondary to other eye disorders, right eye, indeterminate stageH40.52X0 Glaucoma secondary to other eye disorders, left eye, stage unspecifiedH40.52X1 Glaucoma secondary to other eye disorders, left eye, mild stageH40.52X2 Glaucoma secondary to other eye disorders, left eye, moderate stageH40.52X3 Glaucoma secondary to other eye disorders, left eye, severe stageH40.52X4 Glaucoma secondary to other eye disorders, left eye, indeterminate stageH40.53X0 Glaucoma secondary to other eye disorders, bilateral, stage unspecifiedH40.53X1 Glaucoma secondary to other eye disorders, bilateral, mild stageH40.53X2 Glaucoma secondary to other eye disorders, bilateral, moderate stageH40.53X3 Glaucoma secondary to other eye disorders, bilateral, severe stageH40.53X4 Glaucoma secondary to other eye disorders, bilateral, indeterminate stageH40.61X0 Glaucoma secondary to drugs, right eye, stage unspecifiedH40.61X1 Glaucoma secondary to drugs, right eye, mild stageH40.61X2 Glaucoma secondary to drugs, right eye, moderate stageH40.61X3 Glaucoma secondary to drugs, right eye, severe stageH40.61X4 Glaucoma secondary to drugs, right eye, indeterminate stageH40.62X0 Glaucoma secondary to drugs, left eye, stage unspecifiedH40.62X1 Glaucoma secondary to drugs, left eye, mild stageH40.62X2 Glaucoma secondary to drugs, left eye, moderate stageH40.62X3 Glaucoma secondary to drugs, left eye, severe stageH40.62X4 Glaucoma secondary to drugs, left eye, indeterminate stageH40.63X0 Glaucoma secondary to drugs, bilateral, stage unspecifiedH40.63X1 Glaucoma secondary to drugs, bilateral, mild stageH40.63X2 Glaucoma secondary to drugs, bilateral, moderate stageH40.63X3 Glaucoma secondary to drugs, bilateral, severe stageH40.63X4 Glaucoma secondary to drugs, bilateral, indeterminate stageH40.811 Glaucoma with increased episcleral venous pressure, right eyeH40.812 Glaucoma with increased episcleral venous pressure, left eyeH40.813 Glaucoma with increased episcleral venous pressure, bilateralH40.821 Hypersecretion glaucoma, right eyeH40.822 Hypersecretion glaucoma, left eyeH40.823 Hypersecretion glaucoma, bilateralH40.831 Aqueous misdirection, right eyeH40.832 Aqueous misdirection, left eyeH40.833 Aqueous misdirection, bilateralH40.89 Other specified glaucomaH40.9 Unspecified glaucomaH42 Glaucoma in diseases classified elsewhereH44.321 Siderosis of eye, right eyeH44.322 Siderosis of eye, left eyeH44.323 Siderosis of eye, bilateralH44.391 Other degenerative disorders of globe, right eyeH44.392 Other degenerative disorders of globe, left eyeH44.393 Other degenerative disorders of globe, bilateralH46.01 Optic papillitis, right eyeH46.02 Optic papillitis, left eyeH46.03 Optic papillitis, bilateralH46.11 Retrobulbar neuritis, right eyeH46.12 Retrobulbar neuritis, left eyeH46.13 Retrobulbar neuritis, bilateralH46.2 Nutritional optic neuropathyH46.3 Toxic optic neuropathyH46.8 Other optic neuritis


ICD-10 Codes DescriptionH46.9 Unspecified optic neuritisH47.011 Ischemic optic neuropathy, right eyeH47.012 Ischemic optic neuropathy, left eyeH47.013 Ischemic optic neuropathy, bilateralH47.021 Hemorrhage in optic nerve sheath, right eyeH47.022 Hemorrhage in optic nerve sheath, left eyeH47.023 Hemorrhage in optic nerve sheath, bilateralH47.031 Optic nerve hypoplasia, right eyeH47.032 Optic nerve hypoplasia, left eyeH47.033 Optic nerve hypoplasia, bilateralH47.091 Other disorders of optic nerve, not elsewhere classified, right eyeH47.092 Other disorders of optic nerve, not elsewhere classified, left eyeH47.093 Other disorders of optic nerve, not elsewhere classified, bilateralH47.10 Unspecified papilledemaH47.11 Papilledema associated with increased intracranial pressureH47.12 Papilledema associated with decreased ocular pressureH47.13 Papilledema associated with retinal disorderH47.141 Foster-Kennedy syndrome, right eyeH47.142 Foster-Kennedy syndrome, left eyeH47.143 Foster-Kennedy syndrome, bilateralH47.20 Unspecified optic atrophyH47.211 Primary optic atrophy, right eyeH47.212 Primary optic atrophy, left eyeH47.213 Primary optic atrophy, bilateralH47.22 Hereditary optic atrophyH47.231 Glaucomatous optic atrophy, right eyeH47.232 Glaucomatous optic atrophy, left eyeH47.233 Glaucomatous optic atrophy, bilateralH47.291 Other optic atrophy, right eyeH47.292 Other optic atrophy, left eyeH47.293 Other optic atrophy, bilateralH47.311 Coloboma of optic disc, right eyeH47.312 Coloboma of optic disc, left eyeH47.313 Coloboma of optic disc, bilateralH47.321 Drusen of optic disc, right eyeH47.322 Drusen of optic disc, left eyeH47.323 Drusen of optic disc, bilateralH47.331 Pseudopapilledema of optic disc, right eyeH47.332 Pseudopapilledema of optic disc, left eyeH47.333 Pseudopapilledema of optic disc, bilateralH47.391 Other disorders of optic disc, right eyeH47.392 Other disorders of optic disc, left eyeH47.393 Other disorders of optic disc, bilateralH47.41 Disorders of optic chiasm in (due to) inflammatory disordersH47.42 Disorders of optic chiasm in (due to) neoplasmH47.43 Disorders of optic chiasm in (due to) vascular disordersH47.49 Disorders of optic chiasm in (due to) other disordersH47.511 Disorders of visual pathways in (due to) inflammatory disorders, right sideH47.512 Disorders of visual pathways in (due to) inflammatory disorders, left sideH47.519 Disorders of visual pathways in (due to) inflammatory disorders, unspecified sideH47.521 Disorders of visual pathways in (due to) neoplasm, right sideH47.522 Disorders of visual pathways in (due to) neoplasm, left sideH47.531 Disorders of visual pathways in (due to) vascular disorders, right sideH47.532 Disorders of visual pathways in (due to) vascular disorders, left sideH47.611 Cortical blindness, right side of brainH47.612 Cortical blindness, left side of brainH47.621 Disorders of visual cortex in (due to) inflammatory disorders, right side of brainH47.622 Disorders of visual cortex in (due to) inflammatory disorders, left side of brain


ICD-10 Codes DescriptionH47.631 Disorders of visual cortex in (due to) neoplasm, right side of brainH47.632 Disorders of visual cortex in (due to) neoplasm, left side of brainH47.641 Disorders of visual cortex in (due to) vascular disorders, right side of brainH47.642 Disorders of visual cortex in (due to) vascular disorders, left side of brainH49.00 Third [oculomotor] nerve palsy, unspecified eyeH49.01 Third [oculomotor] nerve palsy, right eyeH49.02 Third [oculomotor] nerve palsy, left eyeH49.03 Third [oculomotor] nerve palsy, bilateralH49.11 Fourth [trochlear] nerve palsy, right eyeH49.12 Fourth [trochlear] nerve palsy, left eyeH49.13 Fourth [trochlear] nerve palsy, bilateralH49.21 Sixth [abducent] nerve palsy, right eyeH49.22 Sixth [abducent] nerve palsy, left eyeH49.23 Sixth [abducent] nerve palsy, bilateralH49.31 Total (external) ophthalmoplegia, right eyeH49.32 Total (external) ophthalmoplegia, left eyeH49.33 Total (external) ophthalmoplegia, bilateralH49.41 Progressive external ophthalmoplegia, right eyeH49.42 Progressive external ophthalmoplegia, left eyeH49.43 Progressive external ophthalmoplegia, bilateralH49.881 Other paralytic strabismus, right eyeH49.882 Other paralytic strabismus, left eyeH49.883 Other paralytic strabismus, bilateralH51.0 Palsy (spasm) of conjugate gazeH51.11 Convergence insufficiencyH51.12 Convergence excessH51.20 Internuclear ophthalmoplegia, unspecified eyeH51.21 Internuclear ophthalmoplegia, right eyeH51.22 Internuclear ophthalmoplegia, left eyeH51.23 Internuclear ophthalmoplegia, bilateralH51.8 Other specified disorders of binocular movementH53.001 Unspecified amblyopia, right eyeH53.002 Unspecified amblyopia, left eyeH53.003 Unspecified amblyopia, bilateralH53.011 Deprivation amblyopia, right eyeH53.012 Deprivation amblyopia, left eyeH53.013 Deprivation amblyopia, bilateralH53.021 Refractive amblyopia, right eyeH53.022 Refractive amblyopia, left eyeH53.023 Refractive amblyopia, bilateralH53.031 Strabismic amblyopia, right eyeH53.032 Strabismic amblyopia, left eyeH53.033 Strabismic amblyopia, bilateralH53.10 Unspecified subjective visual disturbancesH53.11 Day blindnessH53.121 Transient visual loss, right eyeH53.122 Transient visual loss, left eyeH53.123 Transient visual loss, bilateralH53.131 Sudden visual loss, right eyeH53.132 Sudden visual loss, left eyeH53.133 Sudden visual loss, bilateralH53.141 Visual discomfort, right eyeH53.142 Visual discomfort, left eyeH53.143 Visual discomfort, bilateralH53.15 Visual distortions of shape and sizeH53.16 Psychophysical visual disturbancesH53.19 Other subjective visual disturbancesH53.2 Diplopia


ICD-10 Codes DescriptionH53.40 Unspecified visual field defectsH53.411 Scotoma involving central area, right eyeH53.412 Scotoma involving central area, left eyeH53.413 Scotoma involving central area, bilateralH53.421 Scotoma of blind spot area, right eyeH53.422 Scotoma of blind spot area, left eyeH53.423 Scotoma of blind spot area, bilateralH53.431 Sector or arcuate defects, right eyeH53.432 Sector or arcuate defects, left eyeH53.433 Sector or arcuate defects, bilateralH53.451 Other localized visual field defect, right eyeH53.452 Other localized visual field defect, left eyeH53.453 Other localized visual field defect, bilateralH53.461 Homonymous bilateral field defects, right sideH53.462 Homonymous bilateral field defects, left sideH53.47 Heteronymous bilateral field defectsH53.481 Generalized contraction of visual field, right eyeH53.482 Generalized contraction of visual field, left eyeH53.483 Generalized contraction of visual field, bilateralH53.52 Acquired color vision deficiencyH53.60 Unspecified night blindnessH53.61 Abnormal dark adaptation curveH53.62 Acquired night blindnessH53.63 Congenital night blindnessH53.69 Other night blindnessH53.71 Glare sensitivityH53.72 Impaired contrast sensitivityH53.8 Other visual disturbancesH53.9 Unspecified visual disturbanceH54.0 Blindness, both eyesH54.11 Blindness, right eye, low vision left eyeH54.12 Blindness, left eye, low vision right eyeH54.2 Low vision, both eyesH54.3 Unqualified visual loss, both eyesH54.41 Blindness, right eye, normal vision left eyeH54.42 Blindness, left eye, normal vision right eyeH54.51 Low vision, right eye, normal vision left eyeH54.52 Low vision, left eye, normal vision right eyeH54.61 Unqualified visual loss, right eye, normal vision left eyeH54.62 Unqualified visual loss, left eye, normal vision right eyeH54.7 Unspecified visual lossH54.8 Legal blindness, as defined in USAH55.00 Unspecified nystagmusH55.01 Congenital nystagmusH55.02 Latent nystagmusH55.03 Visual deprivation nystagmusH55.04 Dissociated nystagmusH55.09 Other forms of nystagmusH55.81 Saccadic eye movementsH55.89 Other irregular eye movementsH57.01 Argyll Robertson pupil, atypicalH59.40 Inflammation (infection) of postprocedural bleb, unspecifiedH59.41 Inflammation (infection) of postprocedural bleb, stage 1H59.42 Inflammation (infection) of postprocedural bleb, stage 2H59.43 Inflammation (infection) of postprocedural bleb, stage 3I60.01 Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcationI60.02 Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcationI60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery


ICD-10 Codes DescriptionI60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral arteryI60.21 Nontraumatic subarachnoid hemorrhage from right anterior communicating arteryI60.22 Nontraumatic subarachnoid hemorrhage from left anterior communicating arteryI60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating arteryI60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating arteryI60.4 Nontraumatic subarachnoid hemorrhage from basilar arteryI60.51 Nontraumatic subarachnoid hemorrhage from right vertebral arteryI60.52 Nontraumatic subarachnoid hemorrhage from left vertebral arteryI60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteriesI60.8 Other nontraumatic subarachnoid hemorrhageI61.0 Nontraumatic intracerebral hemorrhage in hemisphere, subcorticalI61.1 Nontraumatic intracerebral hemorrhage in hemisphere, corticalI61.3 Nontraumatic intracerebral hemorrhage in brain stemI61.4 Nontraumatic intracerebral hemorrhage in cerebellumI61.5 Nontraumatic intracerebral hemorrhage, intraventricularI61.6 Nontraumatic intracerebral hemorrhage, multiple localizedI61.8 Other nontraumatic intracerebral hemorrhageI62.01 Nontraumatic acute subdural hemorrhageI62.02 Nontraumatic subacute subdural hemorrhageI62.03 Nontraumatic chronic subdural hemorrhageI62.1 Nontraumatic extradural hemorrhageI63.011 Cerebral infarction due to thrombosis of right vertebral arteryI63.012 Cerebral infarction due to thrombosis of left vertebral arteryI63.02 Cerebral infarction due to thrombosis of basilar arteryI63.031 Cerebral infarction due to thrombosis of right carotid arteryI63.032 Cerebral infarction due to thrombosis of left carotid arteryI63.09 Cerebral infarction due to thrombosis of other precerebral arteryI63.111 Cerebral infarction due to embolism of right vertebral arteryI63.112 Cerebral infarction due to embolism of left vertebral arteryI63.12 Cerebral infarction due to embolism of basilar arteryI63.131 Cerebral infarction due to embolism of right carotid arteryI63.132 Cerebral infarction due to embolism of left carotid arteryI63.19 Cerebral infarction due to embolism of other precerebral arteryI63.311 Cerebral infarction due to thrombosis of right middle cerebral arteryI63.312 Cerebral infarction due to thrombosis of left middle cerebral arteryI63.321 Cerebral infarction due to thrombosis of right anterior cerebral arteryI63.322 Cerebral infarction due to thrombosis of left anterior cerebral arteryI63.331 Cerebral infarction due to thrombosis of right posterior cerebral arteryI63.332 Cerebral infarction due to thrombosis of left posterior cerebral arteryI63.339 Cerebral infarction due to thrombosis of unspecified posterior cerebral arteryI63.341 Cerebral infarction due to thrombosis of right cerebellar arteryI63.342 Cerebral infarction due to thrombosis of left cerebellar arteryI63.349 Cerebral infarction due to thrombosis of unspecified cerebellar arteryI63.39 Cerebral infarction due to thrombosis of other cerebral arteryI63.411 Cerebral infarction due to embolism of right middle cerebral arteryI63.412 Cerebral infarction due to embolism of left middle cerebral arteryI63.421 Cerebral infarction due to embolism of right anterior cerebral arteryI63.422 Cerebral infarction due to embolism of left anterior cerebral arteryI63.431 Cerebral infarction due to embolism of right posterior cerebral arteryI63.432 Cerebral infarction due to embolism of left posterior cerebral arteryI63.439 Cerebral infarction due to embolism of unspecified posterior cerebral arteryI63.441 Cerebral infarction due to embolism of right cerebellar arteryI63.442 Cerebral infarction due to embolism of left cerebellar arteryI63.49 Cerebral infarction due to embolism of other cerebral arteryI63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral arteryI63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral arteryI63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral arteryI63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery


ICD-10 Codes DescriptionI63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral arteryI63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral arteryI63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar arteryI63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar arteryI63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenicI63.8 Other cerebral infarctionI65.01 Occlusion and stenosis of right vertebral arteryI65.02 Occlusion and stenosis of left vertebral arteryI65.03 Occlusion and stenosis of bilateral vertebral arteriesI65.09 Occlusion and stenosis of unspecified vertebral arteryI65.1 Occlusion and stenosis of basilar arteryI65.21 Occlusion and stenosis of right carotid arteryI65.22 Occlusion and stenosis of left carotid arteryI65.23 Occlusion and stenosis of bilateral carotid arteriesI65.8 Occlusion and stenosis of other precerebral arteriesI65.9 Occlusion and stenosis of unspecified precerebral arteryI66.01 Occlusion and stenosis of right middle cerebral arteryI66.02 Occlusion and stenosis of left middle cerebral arteryI66.03 Occlusion and stenosis of bilateral middle cerebral arteriesI66.11 Occlusion and stenosis of right anterior cerebral arteryI66.12 Occlusion and stenosis of left anterior cerebral arteryI66.13 Occlusion and stenosis of bilateral anterior cerebral arteriesI66.21 Occlusion and stenosis of right posterior cerebral arteryI66.22 Occlusion and stenosis of left posterior cerebral arteryI66.23 Occlusion and stenosis of bilateral posterior cerebral arteriesI66.3 Occlusion and stenosis of cerebellar arteriesI66.8 Occlusion and stenosis of other cerebral arteriesI66.9 Occlusion and stenosis of unspecified cerebral arteryI67.1 Cerebral aneurysm, nonrupturedI67.2 Cerebral atherosclerosisI67.4 Hypertensive encephalopathyI67.5 Moyamoya diseaseI67.6 Nonpyogenic thrombosis of intracranial venous systemI67.7 Cerebral arteritis, not elsewhere classifiedI67.81 Acute cerebrovascular insufficiencyI67.82 Cerebral ischemiaI67.83 Posterior reversible encephalopathy syndromeI67.841 Reversible cerebrovascular vasoconstriction syndromeI67.848 Other cerebrovascular vasospasm and vasoconstrictionI67.89 Other cerebrovascular diseaseI67.9 Cerebrovascular disease, unspecifiedI68.0 Cerebral amyloid angiopathyI68.2 Cerebral arteritis in other diseases classified elsewhereI68.8 Other cerebrovascular disorders in diseases classified elsewhereM05.80 Other rheumatoid arthritis with rheumatoid factor of unspecified siteM06.9 Rheumatoid arthritis, unspecifiedM31.5 Giant cell arteritis with polymyalgia rheumaticaM31.6 Other giant cell arteritisQ10.0 Congenital ptosisQ14.0 Congenital malformation of vitreous humorQ14.1 Congenital malformation of retinaQ14.2 Congenital malformation of optic discQ14.3 Congenital malformation of choroidQ14.8 Other congenital malformations of posterior segment of eyeQ15.0 Congenital glaucomaQ85.00 Neurofibromatosis, unspecifiedQ85.01 Neurofibromatosis, type 1Q85.03 Schwannomatosis


ICD-10 Codes DescriptionQ85.09 Other neurofibromatosisS04.011A -S04.12XS Injury of optic nerve, right eye, initial encounter - Injury of oculomotor nerve, left side, sequela

Z04.71 Encounter for examination and observation following alleged adult physical abuseZ04.72 Encounter for examination and observation following alleged child physical abuse

Z09 Encounter for follow-up examination after completed treatment for conditions other thanmalignant neoplasm

Z76.5 Malingerer [conscious simulation]Z79.4 Long term (current) use of insulinZ79.82 Long term (current) use of aspirinZ79.899 Other long term (current) drug therapy

ICD-10 Codes that DO NOT Support Medical Necessity N/AICD-10 Additional Information

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General InformationAssociated InformationDocumentation Requirements:

The patient's medical record must contain documentation that fully supports the medical necessity for servicesincluded within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is notlimited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Appendices:

Not applicable

Utilization Guidelines:

Not applicable

Sources of Information and Basis for DecisionThis bibliography presents those sources that were obtained during the development of this policy. NationalGovernment Services is not responsible for the continuing viability of Web site addresses listed below.

Mansbereger S, Shaban D. Early detection of glaucomatous visual field loss: why, what, where, and how.Ophthalmol Clin North Am. 2005;18(3):365–373.

Noble J, Greene HL, Levinson W, et al, eds. Textbook of Primary Care Medicine. 3rd ed. St Louis, MO: Mosby;2001.

Other contractors’ LCDs.

Yanoff M, Duker JS. Ophthalmology. 2nd ed. St. Louis, MO: Mosby; 2004.

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Revision History InformationPlease note: Most Revision History entries effective on or before 01/24/2013 display with a Revision HistoryNumber of "R1" at the bottom of this table. However, there may be LCDs where these entries will display as aseparate and distinct row.


https://www.cms.gov/medicare-coverage-database/staticpages/icd9-code-range.aspx?DocType=LCD&DocID=33574&ver=9&Group=1&RangeStart=S04.011A&RangeEnd=S04.12XS&LCDId=33574&ContrId=299&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National%2bGovernment%2bServices%2c%2bInc.%2b(National%2bGovernment%2bServices%2c%2bInc.%2b(13102%2c%2bA%2band%2bB%2band%2bHHH%2bMAC%2c%2bJ%2b-%2bK))&LCntrctr=299*1&kq=42551230&ua=highwire%7cchrome&displayPDFNote=Y&bc=AgACAAIACAAAAA%3d%3d&

https://www.cms.gov/medicare-coverage-database/staticpages/icd9-code-range.aspx?DocType=LCD&DocID=33574&ver=9&Group=1&RangeStart=S04.011A&RangeEnd=S04.12XS&LCDId=33574&ContrId=299&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National%2bGovernment%2bServices%2c%2bInc.%2b(National%2bGovernment%2bServices%2c%2bInc.%2b(13102%2c%2bA%2band%2bB%2band%2bHHH%2bMAC%2c%2bJ%2b-%2bK))&LCntrctr=299*1&kq=42551230&ua=highwire%7cchrome&displayPDFNote=Y&bc=AgACAAIACAAAAA%3d%3d&

RevisionHistory Date

RevisionHistoryNumber

Revision History Explanation Reason(s) for Change

01/01/2016 R4Added ICD-10-CM diagnosis code H53.40 to the ICD-10-CM codes that support medical necessity section,effective for services rendered on or after10/01/2015.

• Request for Coverageby a Practitioner (PartB)

01/01/2016 R3 Based on 2016 HCPS updates, the description waschanged for CPT code 92083.

• Revisions Due ToCPT/HCPCS CodeChanges

10/01/2015 R2 Bill type codes added • ProviderEducation/Guidance

10/01/2015 R1Added ICD-10-CM diagnosis code range to the ICD-10-CM diagnosis codes that support medical necessitysection:S04.011A through S04.12XS.

• ProviderEducation/Guidance

• visual fields• eyes• ophthalmology• vision

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Associated DocumentsAttachments N/A

Related Local Coverage Documents Article(s) A52829 - Visual Fields Testing - Supplemental Instructions Article

Related National Coverage Documents N/A

Public Version(s) Updated on 01/07/2016 with effective dates 01/01/2016 - N/A Updated on 12/22/2015 witheffective dates 01/01/2016 - N/A Updated on 07/10/2015 with effective dates 10/01/2015 - 12/31/2015 Updatedon 06/29/2015 with effective dates 10/01/2015 - N/A Updated on 04/02/2014 with effective dates 10/01/2015 -N/A Back to Top

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https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52829&ver=7&LCDId=33574&ContrId=299&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National%2bGovernment%2bServices%2c%2bInc.%2b(National%2bGovernment%2bServices%2c%2bInc.%2b(13102%2c%2bA%2band%2bB%2band%2bHHH%2bMAC%2c%2bJ%2b-%2bK))&LCntrctr=299*1&DocType=Active&kq=42551230&ua=highwire%7cchrome&displayPDFNote=Y&bc=AgACAAIACAAAAA%3d%3d&

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33574&ver=7&CntrctrSelected=299*1&Cntrctr=299&name=National%2bGovernment%2bServices%2c%2bInc.%2b(National%2bGovernment%2bServices%2c%2bInc.%2b(13102%2c%2bA%2band%2bB%2band%2bHHH%2bMAC%2c%2bJ%2b-%2bK))&LCntrctr=299*1&DocType=Active&kq=42551230&ua=highwire%7cchrome&displayPDFNote=Y&bc=AgACAAIACAAAAA%3d%3d&







https://www.cms.gov/medicare-coverage-database/staticpages/lcd-disclaimer.aspx