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Ophthalmology and Optometry Coding Alert

Forget This Screening Code and Forget Payment From CMS

Published on Sun Aug 28, 2005

Hint: Report V80.1 first for G0117, followed by any identified disease

V codes play a vital role in Medicare's reimbursement for glaucoma screening services - and failure to use them can torpedo your claims.

When submitting claims for 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) you need to report only the reason the patient is being seen - the screening - not any differential diagnosis that the ophthalmologist found, says Regan Bode, CPC, OCS, clinic administrator at the Northwest Eye Clinic in Bellingham, Wash.

For a screening, you have to submit a primary diagnosis code that indicates to the carrier that the patient presented without symptoms.

So even if a patient presents for a glaucoma screening and the ophthalmologist finds concrete symptoms of glaucoma, such as elevated intraocular pressure, you should still link V80.1 (Special screening for neurological, eye, and ear diseases; glaucoma) to G0117 or G0118.

Report Glaucoma Findings as Secondary

If the ophthalmologist does find indications of disease, list the diagnosis as the secondary ICD-9 code, says Raequell Duran, president of Practice Solutions in Santa Barbara, Calif.
 
The Medicare Carriers Manual, section 15021.1, states, "When a diagnostic test is ordered in the absence of signs/symptoms or other evidence of illness or injury, the testing facility or the physician interpreting the diagnostic test should report the screening code as the primary diagnosis code. Any condition discovered during the screening should be reported as a secondary diagnosis."

Example: While performing a glaucoma screening on a 53-year-old black patient, an ophthalmologist finds elevated intraocular pressure.

Report G0117 linked to V80.1 as a primary diagnosis. As a secondary diagnosis, report 365.00 (Borderline glaucoma [glaucoma suspect]; preglaucoma, unspecified).

"Once the physician diagnoses the patient with a type of glaucoma or other condition, you should schedule the patient to return for the appropriate, more extended service and any testing service that may be indicated," Duran says.

Keep Screenings Within CMS Guidelines

Don't forget that in addition to the demographic restrictions on the patient (see "News You Can Use: Amend Your 3-Prong Test for Glaucoma Screening in 2006" later in this issue), to report G0117 or G0118, you must meet the following requirements:
 

  •  An ophthalmologist (or optometrist) must perform the screening test.
     
  •  The patient cannot have had another glaucoma screening within the 11 months following a previous glaucoma screening.
     
  •  The ophthalmologist must perform and document a dilated eye examination with intraocular pressure measure and a direct ophthalmoscopic examination or slit lamp biomicroscopic examination.

    Red flag: Medicare considers serial tonometry (92100), tonography (92120), tonography with water provocation (92130), and provocative tests for glaucoma (92140) included in the glaucoma screening service. Do not report these tests separately if the same physician or someone in the physician group performs them on the same day as the glaucoma screening.

    Don't miss: The physician or physician group cannot report another office visit or consultation on the same day he is coding the glaucoma screening.
     
    "If, after a finding of glaucoma, the physician decides to perform a complete evaluation and management service at the same encounter, then the glaucoma screening is included in the work performed for the E/M code and not separately reportable," says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates in Clearwater, Fla.

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