Visual Field Testing

Description:
Visual field testing is a process to determine defects in the field of vision and tests
the function of the retina, optic nerve and optic pathways. The process may include simple
confrontation (not reimbursable) to increasingly complex studies with sophisticated
equipment.

Indications and Limitations of Coverage and/or Medical Necessity:
The following diagnoses are covered procedures only for the limited visual field examination (CPT 92081):

The lowest level of testing which is medically necessary must be utilized.

Visual field testing is covered for diagnois and treatment of abnormal signs, symptoms, disease or injury. Documentation in the record must establish medical necessity for the service including the frequency of the service.

There must always be a reason for performing the test since routine exams are not covered or medically necessary.

CPT/HCPCS Section: Special opthalmological services

CPT/HCPCS Codes:

ICD-Codes that Support Medical Necessity:
The use of these ICD-9 codes does not abrogate the requirement that medical necessity be documented in the patient's record.

Reasons for Denials:
Lack of medical necessity. Screening examination.

Non-covered ICD-9 Codes:
All other diagnosis codes, which are not listed as covered in the "ICD-9-CM Codes that Support Medical Necessity" section of this policy.

Coding Guidelines:
All services are considered bilateral. Modifier 50 is not appropriate.

The beneficiary is not liable for services denied as not reasonable or necessary unless a waiver has been signed. When this has been completed, the GA modifier should be used.

If the service is performed in a hospital inpatient or outpatient setting, the modifier 26 should be used to indicate the professional component.

If the visual field examination is medically necessary following laser therapy, the appropriate ICD-9 code should be billed as diagnosis #1 and V45.6 (status following surgery of eye and adnexa) should be billed as diagnosis #2.

Documentation Requirements:
For EMC users: when submitting a claim requires supporting documentation, this information can be included in the appropriate "narrative" record for your claim submission format.

When two or more examinations are performed per year per beneficiary, documentation indicating the medical necessity for the procedure must be submitted with the claim.