Close Window
Aetna Aetna
Clinical Policy Bulletin:
External Ocular Photography
Number: 0734


Policy

Aetna considers external ocular photography medically necessary for the following indications to track and serially compare the changes of the condition, where the results may have an impact on management and clinical outcomes:

  • Acid chemical burn of cornea and conjunctival sac
  • Acute inflammation of orbit, unspecified
  • Adherent leucoma
  • Adhesions of iris, unspecified
  • Alkaline chemical burn of cornea and conjunctival sac
  • Anterior dislocation of lens
  • Anterior pigmentation
  • Anterior synechiae
  • Argentous deposits
  • Band-shaped keratopathy
  • Benign neoplasm of conjunctiva
  • Benign neoplasm of cornea
  • Benign neoplasm of eye, part unsepcified
  • Benign neoplasm of eyeball, except retina and choroid
  • Benign neoplasm of eyelid, including canthus
  • Benign neoplasm of lacrimal duct
  • Benign neoplasm of lacrimal gland
  • Benign neoplasm of orbit
  • Benign neoplasm of other specified parts of eye
  • Benign neoplasm of skin of other and unspecified parts of face
  • Blisters, with epidermal loss due to burn (second degree) of eye (with other parts of face, head, and neck)
  • Bullous keratopathy
  • Burn of unspecified degree of eye (with other parts of face, head, and neck)
  • Burn with resulting rupture and destruction of eyeball
  • Carcinoma in situ of eye
  • Carcinoma of eyelid, including canthus
  • Central corneal ulcer
  • Central opacity of cornea
  • Chemical burn of eyelids and periocular area
  • Constant exophthalmos
  • Corneal abscess
  • Corneal deformity, unspecified
  • Corneal degeneration, unspecified
  • Corneal deposit, unspecified
  • Corneal dystrophy, unspecified
  • Corneal ectasia
  • Corneal edema due to wearing of contact
  • Corneal edema, unspecified
  • Corneal membrane change, unspecified
  • Corneal neovascularization, unspecified
  • Corneal opacity, unspecified
  • Corneal staphyloma
  • Corneal ulcer, unspecified
  • Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face, head, and neck), without mention of loss of body part
  • Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face, head, and neck), with loss of a body part
  • Deep vascularization of cornea
  • Degeneration of pupillary margin
  • Degenerative changes of chamber angle
  • Degenerative changes of ciliary body
  • Descematocele
  • Diffuse interstitial keratitis
  • Double pterygium, to follow in lieu of surgery
  • Endothelial corneal dystrophy
  • Erythema due to burn (first degree) of eye (with other parts face, head, and neck)
  • Essential or progressive iris atrophy
  • Exophthalmic ophthalmoplegia
  • Exophthalmos, unspecified
  • Exudative cysts of iris or anterior chamger
  • Folds and rupture of Bowman's membrane
  • Folds in Descemet's membrane
  • Full-thickness skin loss due to burn (third degree NOS) of of eye (with other parts of face, head, and neck)
  • Goniosynechiae
  • Granular corneal dystrophy
  • Herpes simplex disciform keratitis
  • Herpes zoster keratoconjunctivitis
  • Hyphema
  • Hypopyon
  • Hypopyon ulcer
  • Idiopathic corneal edema
  • Idiopathic cysts
  • Implantation cysts
  • Interstitial keratitis, unspecified
  • Iridoschisis
  • Juvenile epithelial corneal dystrophy
  • Kayser-Fleischer ring
  • Keratoconus, acute hydrops
  • Keratoconus, stable condition
  • Keratoconus, unspecified
  • Keratomalacia NOS
  • Late effect of other and unspecified external causes
  • Lattice corneal dystrophy
  • Limbar and corneal involvement in vernal conjunctivitis
  • Localized adhesions and strands of conjunctiva
  • Localized vascularization of cornea
  • Macular cornela dystrophy
  • Malignant neoplasm of conjunctiva, unless excision is planned
  • Malignant neoplasm of the cornea, unless excision is planned
  • Marginal corneal ulcer
  • Minor opacity of cornea
  • Miotic cysts of pupillary margin
  • Mooren's ulcer
  • Mycotic corneal ulcer
  • Neurotrophic keratoconjunctivitis
  • Nodular degeneration of cornea
  • Orbital cellulitis
  • Other and unspecified superficial injuries of eye
  • Other anterior corneal dystrophies
  • Other burn of cornea and conjunctival sac
  • Other burns of eyelids and periocular area
  • Other calcerous degeneration of cornea
  • Other corneal degenerations
  • Other deposits associated with metabolic disorders
  • Other disorders of iris and ciliary body
  • Other forms of keratitis
  • Other prosterior corneal dystrophies
  • Other stromal corneal dystrophies
  • Pannus (corneal)
  • Perforated corneal ulcer
  • Peripheral degenerations of cornea
  • Peripheral opacity of cornea
  • Peripheral pterygium, progressive, to follow in lieu of surgery
  • Phacolytic glaucoma
  • Phlyctenular keratoconjunctivitis
  • Pigmentary iris degeneration
  • Posterior dislocation of lens
  • Posterior pigmentations
  • Posterior synechiae
  • Pseudopterygium
  • Pterygium, unspecified, to follow in lieu of surgery
  • Ptosis of eyelid
  • Pupillary abnormalities
  • Pupillary membranes
  • Recession of chamber angle
  • Recurrent erosion of cornea
  • Recurrent pterygium, to follow in lieu of surgery
  • Ring corneal ulcer
  • Rubeosis iridis
  • Rupture in Descemet's membrane
  • Sclerosing keratitis
  • Secondary corneal edema
  • Stromal pigmentations
  • Subluxation of lens
  • Superficial injury of conjunctiva
  • Superficial injury of cornea
  • Superficial injury of eyelids and periocular area
  • Symblepharon
  • Thyrotoxic exophthalmos
  • Unspecified burn of eye and adnexa
  • Unspecified corneal disorder
  • Unspecified disorder of iris and ciliary body
  • Unspecified keratitis
  • Vascular anomalies of eyelid.

External ocular photography has no proven value for other indications (e.g., evaluating conjunctival hemorrhage, and monitoring pinguecula).

Aetna considers external ocular photography not medically necessary for the sole purpose of documenting the existence of an ocular condition in order to enhance the medical record.



Background

External ocular photography can be used to document the progress or deterioration of certain conditions of the external structures of the eye including the eyelids, lashes, sclerae, conjunctiva and cornea.  It may also be used to document progress and deterioration of structures of the anterior chamber including the iris, and filtration angle.  These photographs are commonly made using slit lamp photography, goniophotography, stereophotography or close-up photography.  Regardless of the technique used for the picture taking, the pictures may be stored as prints, slides, videotape or digital medium.

External ocular photography is clinically useful for tracking slowly progressive conditions over prolonged periods of time, where it may be impractical to document progression with hand drawings due to the need to document fine detail, especialy where there is a lack of anatomic landmarks.

 
CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes covered if selection criteria are met:
92285
ICD-9 codes covered if selection criteria are met:
053.21 Herpes zoster keratoconjunctivitis
054.43 Herpes simplex disciform keratitis
173.10 - 173.19 Other and unspecified malignant neoplasms of eyelid, including canthus
190.3 Malignant neoplasm of conjunctiva
190.4 Malignant neoplasm of cornea
216.1 Benign neoplasm of eyelid, including canthus
216.3 Benign neoplasm of skin of other and unspecified parts of face
224.0 Benign neoplasm of eyeball, except conjunctiva, cornea, retina, and choroid
224.1 Benign neoplasm of orbit
224.2 Benign neoplasm of lacrimal gland
224.3 Benign neoplasm of conjunctiva
224.4 Benign neoplasm of cornea
224.7 Benign neoplasm of lacrimal duct
224.8 Benign neoplasm of other specified parts of eye
224.9 Benign neoplasm of eye, part unspecified
232.1 Carcinoma of eyelid, including canthus
234.0 Carcinoma in situ of eye
364.05 Hypopyon
364.41 Hyphema
364.42 Rubeosis iridis
364.51 Essential or progressive iris atrophy
364.52 Iridoschisis
364.53 Pigmentary iris degeneration
364.54 Degeneration of pupillary margin
364.55 Miotic cysts of pupillary margin
364.56 Degenerative changes of chamber angle
364.57 Degenerative changes of ciliary body
364.60 Idiopathic cysts
364.61 Implantation cysts
364.62 Exudative cysts of iris or anterior chamber
364.70 Adhesions of iris, unspecified
364.71 Posterior synechiae
364.72 Anterior synechiae
364.73 Goniosynechiae
364.74 Pupillary membranes
364.75 Pupillary abnormalities
364.77 Recession of chamber angle
364.81 Floppy iris syndrome
364.89 Other disorders of iris and ciliary body
364.9 Unspecified disorder of iris and ciliary body
365.51 Phacolytic glaucoma
370.00 Corneal ulcer, unspecified
370.01 Marginal corneal ulcer
370.02 Ring corneal ulcer
370.03 Central corneal ulcer
370.04 Hypopyon ulcer
370.05 Mycotic corneal ulcer
370.06 Perforated corneal ulcer
370.07 Mooren's ulcer
370.31 Phlyctenular keratoconjunctivitis
370.32 Limbar and corneal involvement in vernal conjunctivitis
370.35 Neurotrophic keratoconjunctivitis
370.50 Interstitial keratitis, unspecified
370.52 Diffuse interstitial keratitis
370.54 Sclerosing keratitis
370.55 Corneal abscess
370.60 Corneal neovascularization, unspecified
370.61 Localized vascularization of cornea
370.62 Pannus (corneal)
370.63 Deep vascularization of cornea
370.8 Other forms of keratitis
370.9 Unspecified keratitis
371.00 Corneal opacity, unspecified
371.01 Minor opacity of cornea
371.02 Peripheral opacity of cornea
371.03 Central opacity of cornea
371.04 Adherent leucoma
371.10 Corneal deposit, unspecified
371.11 Anterior pigmentation
371.12 Stromal pigmentations
371.13 Posterior pigmentations
371.14 Kayser-Fleischer ring
371.15 Other deposits associated with metabolic disorders
371.16 Argentous deposits
371.20 Corneal edema, unspecified
371.21 Idiopathic corneal edema
371.22 Secondary corneal edema
371.23 Bullous keratopathy
371.24 Corneal edema due to wearing of contact
371.30 Corneal membrane change, unspecified
371.31 Folds and rupture of Bowman's membrane
371.32 Folds in Descemet's membrane
371.33 Rupture in Descemet's membrane
371.40 Corneal degeneration, unspecified
371.42 Recurrent erosion of cornea
371.43 Band-shaped keratopathy
371.44 Other calcerous degeneration of cornea
371.45 Keratomalacia NOS
371.46 Nodular degeneration of cornea
371.48 Peripheral degenerations of cornea
371.49 Other corneal degenerations
371.50 Corneal dystrophy, unspecified
371.51 Juvenile epithelial corneal dystrophy
371.52 Other anterior corneal dystrophies
371.53 Granular corneal dystrophy
371.54 Lattice corneal dystrophy
371.55 Macular corneal dystrophy
371.56 Other stromal corneal dystrophies
371.57 Endothelial corneal dystrophy
371.58 Other posterior corneal dystrophies
371.60 Keratoconus, unspecified
371.61 Keratoconus, stable condition
371.62 Keratoconus, acute hydrops
371.70 Corneal deformity, unspecified
371.71 Corneal ectasia
371.72 Descematocele
371.73 Corneal staphyloma
371.9 Unspecified corneal disorder
372.40 Pterygium, unspecified
372.42 Peripheral pterygium, progressive
372.44 Double pterygium
372.45 Recurrent pterygium
372.52 Pseudopterygium
372.62 Localized adhesions and strands of conjunctiva
372.63 Symblepharon
374.30-374.33 Ptosis of eyelid
374.85 Vascular anomalies of eyelid
376.00 Acute inflammation of orbit, unspecified
376.01 Orbital cellulitis
376.21 Thyrotoxic exophthalmos
376.22 Exophthalmic ophthalmoplegia
376.30 Exophthalmos, unspecified
376.31 Constant exophthalmos
379.32 Subluxation of lens
379.33 Anterior dislocation of lens
379.34 Posterior dislocation of lens
743.61 Congenital ptosis
918.0 Superficial injury of eyelids and periocular area
918.1 Superficial injury of cornea
918.2 Superficial injury of conjunctiva
918.9 Other and unspecified superficial injuries of eye
940.0 Chemical burn of eyelids and periocular area
940.1 Other burns of eyelids and periocular area
940.2 Alkaline chemical burn of cornea and conjunctival sac
940.3 Acid chemical burn of cornea and conjunctival sac
940.4 Other burn of cornea and conjunctival sac
940.5 Burn with resulting rupture and destruction of eyeball
940.9 Unspecified burn of eye and adnexa
941.02 Burn of unspecified degree of eye (with other parts of face, head, and neck)
941.12 Erythema due to burn (first degree) of eye (with other parts face, head, and neck)
941.22 Blisters, with epidermal loss due to burn (second degree) of eye (with other parts of face, head, and neck)
941.32 Full-thickness skin loss due to burn (third degree NOS) of eye (with other parts of face, head, and neck)
941.42 Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face, head, and neck), without mention of loss of body part
941.52 Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face, head, and neck), with loss of a body part
ICD-9 codes not covered for indications listed in the CPB (not all-inclusive):
372.51 Pinguecula
372.72 Conjunctival hemorrhage


The above policy is based on the following references:
  1. Saine PJ. Tutorial: External ocular photography. J Ophthalmic Photography. 2006;28(1):8-20.
  2. HealthNow UMD. Ocular photography, external. Contractor's Determination No. OP016E00. February 20, 2006.
  3. Farrow A. Clinical ocular photography. Br J Ophthalmol. 2000;84(8):363G.


email this page   


Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
Aetna
Back to top