Visual Field Examination

August 10th, 2016 - Chris Woolstenhulme, CPC, CMRS
Categories:   CPT® Coding   Ophthalmology   Optometry  
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The following information from one Medicare payer includes indications and limiatations of coverage as well as Medical Necessity standards for visual field examinations.

92081 Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent)

92082 Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold 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 and static determination within the central 30 deg, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs
30-2, 24-2, or 30/60-2)

The visual field is the area within which objects may be seen when the eye is fixed. To standardize testing, several automated and computerized perimeters are available. However, manual perimeters are also utilized.

Visual field examinations will be considered medically reasonable and necessary under any of the following conditions:

  • The patient has inflammation or disorders of the eyelids potentially affecting the visual field.
  • The patient has a documented diagnosis of glaucoma.

Please note: stabilization or progression of glaucoma can be monitored only by a visual field examination, and the frequency of such examinations is dependent on the variability of intraocular pressure measurements (e.g., progressive increases despite treatment indicate a worsening condition), the appearance of new hemorrhages, and progressive cupping of the optic nerve.

  • The patient is a glaucoma suspect as evidenced by an increase in intraocular pressure, asymmetric intraocular measurements of greater than 2-3 mm Hg between the two eyes, or has optic nerves suspicious for glaucoma which may be manifested as asymmetrical cupping, disc hemorrhage, or an absent or thinned temporal rim.
  • The patient has a documented disorder of the optic nerve,theneurologic visual pathway, or retina.

Please note: patients with a previously diagnosed retinal detachment do not need a pretreatment visual field examination. Additionally, patients with an established diagnosed cataract do not need a follow-up visual field unless other presenting symptomatology is documented. In patients about to undergo cataract extraction, who do not have glaucoma and are not glaucoma suspects, a visual field is not indicated.

  • The patient has had a recent intracranial hemorrhage, an intracranial mass, or a recent measurement of increased intracranial pressure with or without visual symptomatology.
  • The patient has a recently documented occlusion and/or stenosis of cerebral and precerebral arteries, a recently diagnosed transient cerebral ischemia, or giant cell arteritis.
  • The patient is having an initial workup for buphthalmos, congenital anomalies of the posterior segment, or congenital ptosis.
  • The patient has inflammation or disorders of the orbit, potentially affecting the visual field.
  • The patient has sustained a significant eye injury.
  • The patient has an unexplained visual loss which may be described as “trouble seeing” or “vision going in and out."
  • The patient has a pale or swollen optic nerve documented by a visual exam of recent origin.
  • The patient is having some new functional limitations which may be due to visual field loss (e.g., reports by family that patient is running into things).
Thepatientisbeingevaluatedinitiallyformacular degeneration or has experienced central vision loss resulting in vision measured at or below 20/70. Please note:repeatedexaminationsforadiagnosisofmacular degeneration or an experienced central vision loss are not necessary unless changes in vision are documented or to evaluate the results of a surgical intervention.
  • The patient is receiving or has completed treatment of a high-risk medication that may cause visual side effects (e.g., a patient on plaquenil may develop retinopathy).

– Visual Field Examination (L33766)

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