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Ophthalmology and Optometry Coding Alert

Forget Needing a New Chief Complaint With G0117 and G0118

Published on Tue Jul 01, 2003

Don't assume that Medicare won't ever cover a complaint-free visit; there are particular circumstances when these visits are covered.
 
Medicare allows an annual checkup for a patient diagnosed with cataracts, says Erica Kuntz, CPC, COA, in Ohio. Even if the patient does not present with any new problems, you can bill Medicare for the exam, because it's considered a medically necessary follow-up.
 
Medicare also allows a glaucoma screening as a wellness or preventive exam for those patients who meet its criteria (use V80.1, Special screening for neurological, eye, and ear diseases; glaucoma). This is a national policy, says Raequell Duran, president of Practice Solutions in Santa Barbara, Calif. The screening benefit is available for Medicare beneficiaries with diabetes mellitus, a family history of glaucoma, or blacks age 50 and over. The screening service includes dilated eye examination with intraocular pressure, and direct ophthalmoscopy or slit lamp examination.
 
For the screening, use either G0117 (Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist) or G0118 (Glaucoma screening for high-risk patient furnished under the direct supervision of an optometrist or ophthalmologist), Duran says.

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