Endothelial Cell Photography

Number: 0538

Table Of Contents

Policy
Applicable CPT / HCPCS / ICD-10 Codes
Background
References

Policy

Scope of Policy

This Clinical Policy Bulletin addresses endothelial cell photography.

  1. Medical Necessity

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

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

  2. Experimental, Investigational, or Unproven

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

  3. Policy Limitations and Exclusions 

    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).

Table:

CPT Codes / HCPCS Codes / ICD-10 Codes
Code Code Description

Information in the [brackets] below has been added for clarification purposes.   Codes requiring a 7th character are represented by "+":

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

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.

References

The above policy is based on the following references:

  1. American Academy of Ophthalmology Preferred Practice Patterns Committee. Comprehensive adult medical eye evaluation. San Francisco, CA: American Academy of Ophthalmology; 2010.
  2. American Academy of Ophthalmology Refractive Management/Intervention Panel. Refractive errors & refractive surgery. San Francisco, CA: American Academy of Ophthalmology; 2007.
  3. American Academy of Ophthalmology. Corneal endothelial photography. Three-year revision.  Ophthalmology. 1997;104(8):1360-1365 (updated 2008).
  4. Chiou AG, Kaufman SC, Kaufman HE, Beuerman RW. Clinical corneal confocal microscopy. Surv Ophthalmol. 2006;51(5):482-500.
  5. 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.  
  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. 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.
  9. 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.
  10. 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.
  11. Wisconsin Physician Service Insurance Corporation (WPS) Medicare Part B. Endothelial cell photography. Medicare Policy No. OPHTH-012. Madison, WI: WPS; October 1, 1994.