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Ophthalmology and Optometry Coding Alert

READER QUESTION:

Stick to V Codes for Screenings

Published on Sun Jun 01, 2003

Question: If an eligible patient presents for a glaucoma screening, and testing reveals increased intraocular pressure, should I report the IOP diagnosis code or the screening diagnosis code with G0117 (Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist)?

OPC Subscriber

Answer: When submitting claims for screenings, unlike diagnostic tests, you should not report diagnosis codes based on the test's findings; you have to submit the diagnosis code that indicates to the carrier that the patient presented without symptoms for a screening.

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

Don't forget that to report G0117, you must meet the following requirements:

  • The screening test must be performed by the ophthalmologist or optometrist

  • The patient must have one of the following: a) family history of glaucoma, b) diabetes mellitus or c) be at least 50 years old and of black heritage.

  • The patient cannot have had another eye examination within the 11 months following another glaucoma screening

  • A dilated eye examination with intraocular pressure measure and a direct ophthalmoscopic examination or slitlamp biomicroscopic examination must be documented as performed

  • No other office visit or consultation can be billed by the same physician or physician group on the same day as the glaucoma screening is being billed

  • Serial tonometry, tonography, tonography with water provocation and provocative tests for glaucoma are also considered included in the glaucoma screening service and cannot be reported separately by the same physician or physician group on the same day as the glaucoma screening

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