Independence is updating our policies on scanning computerized ophthalmic diagnostic imaging (SCODI) to reflect changes in medical necessity criteria and the covered diagnosis codes.
The following policies were posted as Notifications on the Medical Policy Portal on June 13, 2018, and will go into effect September 10, 2018:
- Commercial: #07.13.06k: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
- Medicare Advantage: #MA07.004d: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Medical Necessity criteria
As part of the update, medical necessity criteria for SCODI are being amended as follows:
- The conditions covered for anterior segment evaluation will include specified forms of glaucoma and certain disorders of the cornea, iris, and ciliary body.
- The conditions covered for posterior segment evaluation will include conditions affecting the optic nerve (e.g., optic neuropathy) or retinal disease (e.g., macular degeneration, diabetic retinopathy) and certain macular abnormalities (e.g., macular edema, atrophy associated with degenerative retinal diseases).
- The covered retinal conditions in active treatment, for which one exam, per eye, per month may be appropriate, will include wet age-related macular degeneration (AMD), choroidal neovascularization, macular edema, diabetic retinopathy (proliferative and nonproliferative), branch retinal vein occlusion, central retinal vein occlusion, and cystoid macular edema.
- The timing of monitoring individuals being treated with chloroquine (CQ) and/or hydroxychloroquine (HCQ) will be changed to align with the U.S. Food and Drug Administration labeling.
? Baseline examination will be within the first year of treatment and as an annual follow-up after five years of treatment. For higher-risk individuals, annual testing may begin immediately (without a five-year delay).
Diagnosis codes
The diagnosis codes representing covered conditions for SCODI are being updated in the ICD-10 Diagnosis Code Number(s) and Narrative(s) section of the coding table.
For more information
To view the Notifications for these policies, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select Commercial or Medicare Advantage under Active Notifications.