Medical necessity rules are met when a patient presents with a sign or symptom of dry eye as determined by the clinician, which should be documented in the patient's medical record. Codes commonly used for coding dry eye diagnosis and/or dry eye symptoms, as referenced in the clinical literature, are listed in the "ICD-10 Coding for Dry Eye" brochure, available on the TearLab website.
Currently CMS has no National Coverage Determinations (NCD) that define diagnosis codes to bill for CPT 83861 tear osmolarity test, so a decision to perform a test based on signs or symptoms of dry eye is up to the physician. Florida Medicare Providers, please refer to "Florida First Coast LCD" on the TearLab website for information on Medicare coverage for dry eye testing.
Always ensure that all the items listed below in "Documenting a Laboratory Test" are included in the patient record to meet medical necessity guidelines.