Medical Necessity a Must for Medicare Glaucoma Screening
Published on Mon Nov 24, 2003
Make sure you know the definition of "high-risk patients" to determine who is eligible for Medicare coverage for glaucoma screenings.
Since Jan. 1, 2002, Medicare has reimbursed practices for screening those who meet the definition for being at high risk for the disease. This group includes those with a family history of glaucoma, those with diabetes mellitus, and blacks over age 50.
The screening service has to be furnished by or under the supervision of an optometrist or ophthalmologist who is legally authorized to perform such services in the state where the services are furnished.
Ophthalmologists initially welcomed Medicare's decision to cover glaucoma screening, but using these codes requires understanding the limitations of G0117 (Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist) and G0118 (Glaucoma screening for high-risk patient furnished under the direct supervision of an optometrist or ophthalmologist).
Codes G0117 and G0118 include a dilated examination (DE), intraocular pressure (IOP) measurement, a test for visual acuity, and direct ophthalmoscopy or a slit-lamp biomicroscopic exam.
Codes G0117 and G0118 are bundled with E/M services 99201-99215, 99241-99245, 99301-99303, 99311-99313, 99315-99316, 99321-99323, 99331-99333, 99341-99345, 99347-99350 (all with an indicator of 1) and eye exam codes 92002-92014 (all with a 0 indicator) because the glaucoma screening and an ophthalmic evaluation are not payable on the same day.
The following codes are also bundled with glaucoma screening: 92100 (Serial tonometry [separate procedure] with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day [e.g., diurnal curve or medical treatment of acute elevation of intraocular pressure]), 92120 (Tonography with interpretation and report, recording indentation tonometer method or perilimbal suction method), 92130 (Tonography with water provocation) and 92140 (Provocative tests for glaucoma, with interpretation and report, without tonography).
Medicare accepts only one diagnosis code, V80.1 (Special screening for neurological, eye, and ear diseases; glaucoma), for G0117 and G0118.
Use G0118 with caution. Some payers suggest that G0118 violates state laws because only an optometrist or ophthalmologist is licensed by the state to perform a DE. Theoretically, however, a physician could perform the DE and a technician could perform the rest of the screening, but this is unlikely. Who Is Covered? When patients call for an appointment for the "free" glaucoma screening (as with all Medicare services, the patient must pay a 20 percent copayment), the front desk should ask if the patient has a family history of glaucoma, has diabetes mellitus, or is black and age 50 or over and covered by Medicare.
Be sure to ask if the patient has both Part A and Part B coverage. Physician's services are paid under Part B.
If the patient falls into one of these risk groups, schedule the examination.
If the patient [...]
