Ophthalmology and Optometry Coding Alert

Question: Our office sometimes performs glaucoma screenings for patients who don't meet Medicare's definition of "high risk." How should we code to be reimbursed for this service? Nevada Subscriber Answer: You should have the patient sign an advance beneficiary notice (ABN) and submit a claim of G0117-GA (Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist; Waiver of liability statement on file). Medicare will then deny the claim and send an EOB to the patient, explaining that he is not considered at high risk for glaucoma. Medicare covers glaucoma screenings for high-risk patients, but the doctor isn't sure the patient will meet Medicare's description of "high risk." When your office performs a service -- even a non-covered procedure like certain glaucoma screenings -- you deserve payment for it. If you don't want to get caught absorbing the cost of services that a patient requests or the ophthalmologist recommends, and you [...]