Ophthalmology and Optometry Coding Alert

Question: How do we report glaucoma screening, and who can perform it?

Florida Subscriber

Answer: CMS considers screening for glaucoma to be reasonable and necessary for the early detection and prevention of the illness. Glaucoma screening can be performed by or furnished under direct supervision of an optometrist or ophthalmologist. Direct supervision, under the guidelines, means that a physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure.

You’ll report 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) for your glaucoma screenings, depending on who performs the service.

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 service 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.

While anyone can develop glaucoma, certain groups of people are at higher risk of developing this disease. The screening services that Medicare covers are only available to those high-risk patients. Risk factors typically include age, race, family history, and medical history.

Annual coverage is available for glaucoma screenings for certain eligible Medicare patients who are considered high risk, using the following criteria:

• Those with diabetes mellitus
• Individuals with a family history of glaucoma
• African-Americans age 50 and over
• Hispanic-Americans age 65 and over

Although you can add other screening services during the glaucoma screenings, your documentation must at the very least include both of these components to collect from Medicare:

• Dilated eye examination with an intraocular pressure measurement
• Direct ophthalmoscopy examination or a slit-lamp bio microscopic examination

Keep in mind that only ICD-10-CM code Z13.5 (Encounter for screening for eye and ear disorders) can be reported with the screening, regardless of the findings. In addition, no other services are billable on the same day as screening.