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Endothelial Cell Photography

Number: 0538



Policy

Aetna considers endothelial cell photography medically necessary for members with any of the following indications:

  • Are about to be fitted with extended wear contact lenses after intraocular surgery; or
  • Are about to undergo a secondary intraocular lens implantation; or
  • Are about to undergo a surgical procedure associated with a higher risk to corneal endothelium; or
  • Have had previous intraocular surgery and require cataract surgery; or
  • Have slit-lamp evidence of corneal edema (unilateral or bilateral); or
  • Have slit-lamp evidence of endothelial dystrophy (corneal guttata, i.e., Fuch's dystrophy); or
  • With evidence of posterior polymorphous dystrophy of the cornea or irido-corneal endothelium syndrome.

Aetna considers endothelial cell photography experimental and investigational for other indications because it has no proven clinical value for other indications.

Note: Endothelial cell photography is considered an integral part of the pre-surgical comprehensive or brief/intermediate eye examination when done prior to cataract surgery when the member's only visual problem is cataracts.  This is true regardless of the type of cataract technique utilized (including phaco-emulsification).

Background

Endothelial cell photography (also known as specular endothelial microscopy, anterior segment photography, and corneal endothelial microscopy) involves the use of a specular microscope to determine the endothelial cell count.  It is used by ophthalmologists to predict success of ocular surgery and other ocular procedures.

CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes covered if selection criteria are met:
92286 Special anterior segment photography with interpretation and report; with specular endothelial microscopy and cell count
92287     with fluorescein angiography
ICD-9 codes covered if selection criteria are met (not all-inclusive):
371.20 - 371.24 Corneal edema
371.57 Endothelial corneal dystrophy
371.58 Other posterior corneal dystrophies
Other ICD-9 codes related to the CPB:
366.00 - 366.9 Cataract
743.30 - 743.34 Congenital cataract
996.53 Mechanical complications due to ocular lens prosthesis
V43.1 Replacement of lens by prosthesis
CPT Codes / HCPCS Codes / ICD-10 Codes
Information in the [brackets] below has been added for clarification purposes.   Codes requiring a 7th character are represented by "+":
ICD-10 codes will become effective as of October 1, 2015:
CPT codes covered if selection criteria are met:
92286 Special anterior segment photography with interpretation and report; with specular endothelial microscopy and cell count
92287     with fluorescein angiography
ICD-10 codes covered if selection criteria are met (not all-inclusive):
H18.10 - H18.239 Bullous keratopathy and other and unspecified corneal edema
H18.51 Endothelial corneal dystrophy
H18.59 Other hereditary corneal dystrophies


The above policy is based on the following references:
    1. Wisconsin Physician Service Insurance Corporation (WPS) Medicare Part B. Endothelial cell photography. Medicare Policy No. OPHTH-012. Madison, WI: WPS; October 1, 1994. Available at: http://www.wpsic.com/medicare/policy/wisconsin/opht12W.html. Accessed April 3, 2000.
    2. U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research (AHCPR). Cataract in adults: Management of functional impairment. Clinical Practice Guideline No. 4. AHCPR Publication No. 93-0544. Rockville, MD: AHCPR; February 1993.
    3. American Academy of Ophthalmology. Corneal endothelial photography. Three-year revision.  Ophthalmology. 1997;104(8):1360-1365 (updated for currency 2008).
    4. U.S. Department of Health and Human Services, Health Care Financing Administration (HCFA). Endothelial cell photography. Medicare Coverage Issues Manual §50-38. HCFA Publication No. 6. Baltimore, MD: HCFA; 2000.
    5. Modis L Jr, Langenbucher A, Seitz B. Corneal endothelial cell density and pachymetry measured by contact and noncontact specular microscopy. J Cataract Refract Surg. 2002;28(10):1763-1769.
    6. Hara M, Morishige N, Chikama T, Nishida T. Comparison of confocal biomicroscopy and noncontact specular microscopy for evaluation of the corneal endothelium. Cornea. 2003;22(6):512-515.
    7. Klais CM, Buhren J, Kohnen T. Comparison of endothelial cell count using confocal and contact specular microscopy. Ophthalmologica. 2003;217(2):99-103.
    8. de Sanctis U, Machetta F, Razzano L, et al. Corneal endothelium evaluation with 2 noncontact specular microscopes and their semiautomated methods of analysis. Cornea. 2006;25(5):501-506.  
    9. Chiou AG, Kaufman SC, Kaufman HE, Beuerman RW. Clinical corneal confocal microscopy. Surv Ophthalmol. 2006;51(5):482-500.
    10. American Academy of Ophthalmology Refractive Management/Intervention Panel. Refractive errors & refractive surgery. San Francisco, CA: American Academy of Ophthalmology; 2007.
    11. American Academy of Ophthalmology Preferred Practice Patterns Committee. Comprehensive adult medical eye evaluation. San Francisco, CA: American Academy of Ophthalmology; 2010.


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