| MP 9.03.05 | Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy | |
| Medical Policy | ||
| Section Miscellaneous Policies |
Original Policy Date 11/1/97 |
Last Review Status/Date Reviewed by consensus/4:2009 |
| Issue 4:2009 |
Return to Medical Policy Index |
Disclaimer
Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.
Description
Corneal topography describes measurements of the curvature of the cornea. An evaluation of corneal topography is necessary for the accurate diagnosis and follow-up of certain corneal disorders, such as keratoconus, difficult contact lens fits, and pre- and postoperative assessment of the cornea, most commonly after refractive surgery. Various techniques and instruments are available to measure corneal topography:
- The keratometer (also referred to as an ophthalmometer), the most commonly used instrument, projects an illuminated image onto a central area in the cornea. By measuring the distance between a pair of reflected points in both of the cornea’s two principal meridians, the keratometer can estimate the radius of curvature of two meridians. The fact that the keratometer can only estimate the corneal curvature over a small percentage of its surface, and that estimates are based on the frequently incorrect assumption that the cornea is spherical, are limitations of this technique.
- The keratoscope is an instrument that reflects a series of concentric circular rings off the anterior corneal surface. Visual inspection of the shape and spacing of the concentric rings provides a qualitative assessment of topography. A photokeratoscope is a keratoscope equipped with a camera that can provide a permanent record of the corneal topography.
- Computer-assisted photokeratoscopy is an alternative to keratometry or keratoscopy in measuring corneal curvature. This technique uses sophisticated image analysis programs to provide quantitative corneal topographic data. Early computer-based programs were combined with keratoscopy to create graphic displays and high-resolution color-coded maps of the corneal surface. Newer technologies measure both curvature and shape, enabling quantitative assessment of corneal depth, elevation and power.
A number of devices have received clearance for marketing through the Food and Drug Administration (FDA) 510(k) mechanism. The Orbscan (manufactured by Orbtek and distributed by Bausch and Lomb) received FDA clearance in 1999. The second generation Orbscan II is a hybrid system that uses both projective (slit scanning) and reflective (Placido) methods. The Pentacam (Oculus) is one of a number of rotating Scheimpflug imaging systems produced in Germany.
Policy
Non-computer assisted corneal topography is considered part of the evaluation/and management services of general ophthalmological services (CPT codes 92002–92014), and therefore this service should not be billed separately. There is no separate CPT code for this type of corneal topography.
Computer-assisted corneal topography is considered not medically necessary to detect or monitor diseases of the cornea.
Policy Guidelines
The American Academy of Ophthalmology has petitioned for an explicit CPT code for corneal topography on several occasions in the past. Previously, the CPT committee considered the procedure as part of the evaluation and management level of service or part of the general ophthalmology examination and no explicit CPT code was issued for corneal topography despite its use in practice.
Effective January 1, 2007, computer-assisted corneal topography may be billed separately using a unique CPT code:
92025: Computerized corneal topography, unilateral or bilateral, with interpretation and report.
Non-computer-assisted corneal topography should be considered inclusive to evaluation/and management services.
Benefit Application
BlueCard/National Account Issues
Some of these services may be provided as part of care that is not generally covered under health insurance contracts, such as:
-
Contact lens fitting
-
Refractive surgery
Thus, review for these services excluded by the contract may also be needed.
Rationale
Assessing corneal topography has been done for many years and is a part of the standard ophthalmologic examination of some patients. (1, 2) However, there are multiple ways to evaluate/determine corneal topography. A 1999 American Academy of Ophthalmology (AAO) Assessment indicates that computer-assisted corneal topography evolved from the need to measure corneal curvature and topography more comprehensively and accurately than keratometry and that corneal topography is used primarily for refractive surgery. (3)
The AAO indicates several other potential uses; 1) to evaluate and manage patients following penetrating keratoplasty, 2) planning astigmatic surgery; 3) to evaluate patients with unexplained visual loss and document visual complications; and 4) contact lens fitting. However, the AAO Assessment noted that data are lacking to support the use of objective measurements as opposed to subjective determinants (subjective refraction) of astigmatism.
Updated searches of the MEDLINE database, performed through January 2009, did not identify any studies that would alter the conclusions reached above. Computer-assisted corneal topography has been used for early identification and quantitative documentation of the progression of kerotoconic corneas, and there is sufficient evidence to indicate that computer-assisted topographical mapping can detect and monitor disease. However, the question that is pertinent to this policy is whether quantitative measurement results in an intervention change that improves health outcomes. With the exception of refractive surgery, a service not generally covered as a health insurance benefit, no studies have shown clinical benefit (e.g., a change in treatment decisions) from a quantitative rather than qualitative evaluation of corneal topography. Therefore, based on a lack of scientific evidence from appropriately constructed clinical trials that confirm improved health outcomes, quantitative evaluation of corneal topography, including with computer assistance, is considered not medically necessary.
Medicare National Coverage
There is no national Medicare coverage decision for this testing.
References:
- Morrow GL, Stein RM. Evaluation of corneal topography: past, present and future trends. Can J Ophthalmol 1992; 27(5):213–25.
- Wilson SE, Klyce SD. Advances in the analysis of corneal topography. Surv Ophthalmol 1991; 35(4):269–77.
- Ophthalmic Technology Assessment Committee Cornea Panel: American Academy of Ophthalmology. Corneal topography. Ophthalmology 1999; 106(8):1628-38
|
Codes |
Number |
Description |
| CPT | 92025 | Computerized corneal topography, unilateral or bilateral, with interpretation and report (effective 1/1/07) |
| 92002–92014 | General ophthalmological services | |
| ICD-9 Procedure | 95.02 | Comprehensive eye examination |
| 95.09 | Eye examination, not otherwise specified | |
| ICD-9 Diagnosis | Investigational for all codes | |
| HCPCS | No Code | |
| Type of Service | Ophthalmology | |
| Place of Service | Physician’s Office | |
Index
Corneal topography
Keratometry
Keratoscopy
Photokeratoscopy
Topography, corneal
Policy History
| Date | Action | Reason |
| 11/1/97 | Add to Vision section | New policy |
| 7/12/02 | Replace policy | Policy reviewed without literature review; new review date only |
| 10/09/03 | Replace policy | Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled |
| 10/10/2006 | Replace policy | Policy updated with literature review. Policy statement revised. |
| 12/13/07 | Replace Policy | Policy updated with literature review; reference 3 added; policy statement unchanged. |
| 04/24/09 | Replace policy | Policy updated with literature review through January 2009; policy statement changed to not medically necessary. |
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