Ophthalmology and Optometry Coding Alert

Answer: 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 eye care provider 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 — they 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.

Note: Medicare reimburses code G0117 but not G0118, and no other services can be provided and billed on the same day as a glaucoma screening service.

Remember: Only ICD-10 code Z13.5 (Encounter for screening for eye and ear disorders) may be reported on a claim with the screening service (G0117/G0118), regardless of the findings. But if the ophthalmologist performs a glaucoma screening and confirms a diagnosis of glaucoma, for future visits, you should report the type of glaucoma established, such as H40.1131 (Primary open-angle glaucoma, bilateral, mild stage), as the primary diagnosis.