Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist keeps circling E/M codes like 99212 when he performs glaucoma screenings for high-risk Medicare patients, but we think this is inappropriate. Which code applies to these screenings?

Tennessee Subscriber

Answer: When you perform a glaucoma screening on a high-risk Medicare patient, you’ll report 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). In addition, report ICD-10 code Z13.5 (Encounter for screening for eye and ear disorders) as the diagnosis code to use for a glaucoma screening.

The difference between G0117 and G0118 is that the physician performs the service described by G0117, while the physician supervises another clinical staff member in the code described by G0118. To qualify for G0118, the services must be furnished under the direct supervision of an ophthalmologist or optometrist. Direct supervision means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. Often this is performed by a tech, but keep in mind that state laws dictate who can legally perform glaucoma screenings in each state.

Bottom line: If the doctor is out to lunch, on vacation, out sick, or otherwise not available in the office suite, you cannot report a service as if it was furnished under the doctor’s direct supervision.

Keep in mind that these codes can only be billed once a year. The Correct Coding Initiative (CCI) bundles the glaucoma screening codes into both the E/M codes and the eye codes. Therefore, if the physician sees the patient for an eye exam and performs the glaucoma screening during that visit, you’ll report the E/M code or the eye code, but not the screening.

Remember that these G codes refer to screenings. If a patient is diagnosed with glaucoma, you’ll no longer perform screenings, and after that, the E/M codes would be perfectly acceptable in place of the HCPCS codes.