External Ocular Photography
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This policy governs when external ocular photography is considered medically necessary or not for documenting and tracking external and anterior segment eye conditions for Aetna members and applies to providers submitting for coverage.
No material clinical or coverage changes in this revision.
Coverage Criteria for External Ocular Photography
Coverage criteria
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:
ALL of the following
- 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 unspecified
- 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
- Blepharitis
- 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
- Cicatricial pemphigoid
- Congenital ptosis
- Conjunctival melanosis
- 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
- Dermatochalasis of upper eyelids
- Descematocele
- Diffuse interstitial keratitis
- Double pterygium, to follow in lieu of surgery
- Endothelial corneal dystrophy
- Ectropion
- Entropion
- 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 chamber
- Floppy eyelid syndrome
- Folds and rupture of Bowman's membrane
- Folds in Descemet's membrane
- Full-thickness skin loss due to burn (third degree NOS) of eye (with other parts of face, head, and neck)
- Giant papillary conjunctivitis
- 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
- Lagophthalmos (cicatricial, mechanical, and paralytic)
- Late effect of other and unspecified external causes
- Lattice corneal dystrophy
- Limbal and corneal involvement in vernal conjunctivitis
- Localized adhesions and strands of conjunctiva
- Localized vascularization of cornea
- Macular corneal 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 calcareous degeneration of cornea
- Other corneal degenerations
- Other deposits associated with metabolic disorders
- Other disorders of iris and ciliary body
- Other forms of keratitis (e.g., superficial punctate keratopathy)
- Other posterior 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
- Scleral melanosis
- 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.
Coverage criteria
External ocular photography is not recommended or is considered not medically necessary in the following situations:
ANY of the following
- External ocular photography has no proven value for other indications (examples): anterior scleritis; collapsed orbital wall; enophthalmos following orbital floor fracture; epiblepharon with trichiasis; sinonasal tumor; evaluating conjunctival hemorrhage; keratoconjunctivitis sicca; recurrent dacryoadenitis; recurrent episcleritis; monitoring pinguecula; ocular rosacea; use following rectus muscle surgery for exotropia; and White-Sutton syndrome
Source: policy text and background evidence reviews
- Not medically necessary when used solely to document the existence of an ocular condition for the purpose of enhancing the medical record
- Guidelines and reviews do not recommend external ocular photography as a diagnostic or management tool for dry eye/Keratoconjunctivitis sicca (AAO 2013; UpToDate reviews)
- UpToDate reviews and other evidence summaries generally do not mention external ocular photography as an evaluation/management tool for epiblepharon with trichiasis, ocular rosacea, recurrent dacryoadenitis, or recurrent episcleritis
- While external ocular photography can be used to document eyelid margin and inferior cornea appearance and assist treatment planning in floppy eyelid syndrome, use should be limited to cases where serial comparison will affect management (background literature)
Coding — CPT and ICD-10
| 92285 | External ocular photography with interpretation and report for documentation of medical progress (e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography). |
| B00.52 | Herpesviral keratitis. |
| B02.33 | Zoster keratitis. |
| C44.101 - C44.1992 | Other and unspecified malignant neoplasm of eyelid, including canthus. |
| C69.00 - C69.02 | Malignant neoplasm of conjunctiva. |
| C69.10 - C69.12 | Malignant neoplasm of cornea. |
| D04.10 - D04.122 | Carcinoma in situ of skin of eyelid, including canthus. |
| D09.20 - D09.22 | Carcinoma in situ of eye. |
| D23.10 - D23.122 | Other benign neoplasm of skin of eyelid, including canthus. |
| D23.30 - D23.39 | Other benign neoplasm of skin of other and unspecified parts of face. |
| D31.00 - D31.92 | Benign neoplasm of eye and adnexa (includes conjunctiva, cornea, ciliary body, lacrimal gland and duct, orbit, unspecified part of eye). |
| C31.0 - C31.9 | Malignant neoplasm of accessory sinuses. |
| C78.39 | Secondary malignant neoplasm of other respiratory organs. |
| D02.3 | Carcinoma in situ of other parts of respiratory system. |
| D14.0 | Benign neoplasm of middle ear, nasal cavity and accessory sinuses. |
| D38.5 | Neoplasm of uncertain behavior of other respiratory organs. |
| D49.1 | Neoplasm of unspecified behavior of respiratory system. |
| F79 | Unspecified intellectual disabilities [White–Sutton syndrome]. |
| H02.051 - H02.059 | Trichiasis without entropian. |
| H04.001 - H04.029 | Dacryoadenitis. |
| H05.421 - H05.429 | Enophthalmos due to trauma or surgery. |
| 92285 | External ocular photography (when selection criteria are met). |
Provider Actions — Authorization, Documentation, and Billing
Coverage when criteria met for CPT 92285
CPT 92285 (external ocular photography with interpretation and report) is covered when the policy's selection criteria/indications are met.
No prior-authorization codes specified
This portion of the document does not specify any CPT or HCPCS codes that require prior authorization.
No step therapy specified
No step therapy protocol is specified in this policy.
No step therapy requirements described
The policy does not describe any step therapy requirements for external ocular photography.
Clinical documentation and storage for external ocular photographs
External ocular photographs should document progress or deterioration of external eye structures (eyelids, lashes, sclerae, conjunctiva, cornea) and anterior chamber structures (iris, filtration angle); images may be stored as prints, slides, videotape or digital media.
- Use slit lamp, goniophotography, stereophotography or close-up techniques as appropriate.
- Store images in an appropriate medium (prints, slides, videotape, or digital) to support serial comparison.
Documentation guidance from cited literature (FES, KCS, corneal conditions)
Literature cited notes external ocular photography can document eyelid margin and inferior corneal appearance in floppy eyelid syndrome and can document ocular surface findings in some corneal conditions; however, multiple reviews and guidelines do not list photography as a routine management or diagnostic tool for several conditions.
- Floppy eyelid syndrome: photography useful to document eyelid margin and inferior cornea appearance (Donnenfeld et al., Ezra et al., Lee et al.).
- Keratoconjunctivitis sicca: UpToDate and AAO guidelines do not recommend routine external ocular photography for diagnosis or follow-up.
Denial risk when used for non-supported indications
Claims for external ocular photography may be denied when used for indications the policy states have no proven value (examples include anterior scleritis, epiblepharon with trichiasis, evaluating conjunctival hemorrhage, keratoconjunctivitis sicca, monitoring pinguecula, ocular rosacea, dacryoadenitis, episcleritis, White–Sutton syndrome).
- Avoid billing for external ocular photography when done solely to document existence of a condition listed as having no proven value, as these are considered not medically necessary.
No explicit prior-authorization requirements stated
There are no explicit authorization or prior-authorization requirements stated in this portion of the policy.
Background
External ocular photography is used to document progress or deterioration of external eye and anterior chamber structures, including eyelids, lashes, sclera, conjunctiva, cornea, iris, and filtration angle. Common techniques include slit‑lamp photography, goniophotography, stereophotography and close‑up photography, and images may be stored as prints, slides, videotape or digital media when serial comparison is needed to inform clinical management.
Definitions and Clinical Terms
Revision History
Policy last reviewed on 09/22/2023; document indicates this review date in the policy history section.
Policy effective date recorded as 08/10/2007.
Next scheduled review date listed as 08/08/2024.
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