Ophthalmology and Optometry Coding Alert

CMS proposes making Hispanics 65 and older eligible for G0117 Next year you may have to ask one more question when determining whether a patient is eligible for a Medicare-covered glaucoma screening: "Are you a Hispanic age 65 or older?"

Medicare wants to add that criterion to the list of high-risk indicators that qualify a patient for a glaucoma screening, G0117 (Glaucoma screening for high-risk patient furnished by an optometrist or ophthalmologist) or G0118 (Glaucoma screening for high-risk patient furnished under the direct supervision of an optometrist or ophthalmologist).

The glaucoma screening is now only for high-risk patients, says Kathy Sellers, CPC, coder for Maine Eye Center in Portland. Medicare defines "high-risk" patients as:   People with a family history of glaucoma
   People with diabetes mellitus (250.xx)
   Blacks age 50 and over. The patient must also already be a Medicare beneficiary.
 
Recent studies on the prevalence of glaucoma that separated data for Hispanic persons found that "Hispanic subjects had a marked higher prevalence in the oldest age group," according to the proposed rule, found in the Aug. 8, 2005, Federal Register.

"The prevalence of open angle glaucoma in Hispanic persons age 65 years and older was significantly higher than among whites."

If Medicare adopts this proposal in the final rule, then effective Jan. 1, 2006, "Hispanic Americans age 65 and older would qualify for Medicare coverage and payment for glaucoma screening services," says the proposed rule.

Note: For more information on coding for glaucoma screenings for Medicare beneficiaries, see "Forget This Screening Code and Forget Payment From CMS" previously in this issue.