Determining eligibility comes before you even start to think about G0117 and G0118 Choosing the correct code for a glaucoma screening can be tricky -- add in Medicare's complicated eligibility requirements and you could be seeing red every time your ophthalmologist performs a screening service. Let our expert answers to your top glaucoma screening questions put you on the right track for screening reimbursement you can rely on. Question 1: Who Qualifies for Glaucoma Screening Exams? Make sure you know the definition of "high-risk patients" and how to determine if a patient is eligible for Medicare coverage for glaucoma screenings before reporting your ophthalmologist's services to Medicare.
"Patients who are considered high risk are eligible for a screening glaucoma exam once every 12 months," says Regan Bode, CPC, CPC-EMC, OCS, a coding consultant from Seattle and founder of Eyecoding.net.
Since Jan. 1, 2002, Medicare has reimbursed practices for screening patients who meet the definition of high risk for the disease. As of Jan. 1, 2006, there are four high-risk categories the patient could fall into. Those eligible for the screening now include:
• people with a family history of glaucoma
• people with diabetes mellitus (250.xx)
• blacks age 50 and older
• Hispanics age 65 and older.
Remember: An optometrist or ophthalmologist who is legally authorized to perform such services in the state where the services are furnished must perform or supervise the screening.
What's involved: According to Medicare's guidelines, a qualifying glaucoma screening exam consists of:
• a dilated eye examination with an intraocular pressure measurement
• a direct ophthalmoscopy examination, or a slit-lamp biomicroscopic examination. Tip: Visit
www.cms.hhs.gov/glaucomascreening to read more on Medicare's glaucoma screening guidance.
Question 2: Which CPT Codes Should I Report? You have two coding options when it comes to reporting glaucoma screenings to Medicare: G0117 (Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist) and G0118 (Glaucoma screening for high-risk patient furnished under the direct supervision of an optometrist or ophthalmologist).
Caution: Remember that using code G0117 or G0118 means you're unable to report several other services. "If any other item (exam or any diagnostic tests like a visual field) is billed on the same day as the screening, the screening will bundle into that code and will not be paid separately," Bode says.
Codes G0117 and G0118 both include a dilated examination (DE), intraocular pressure (IOP) measurement, a test for visual acuity, and direct ophthalmoscopy or a slit-lamp biomicroscopic exam.
The National Correct Coding Initiative bundles G0117 and G0118 with E/M services 99201-99215, 99241-99245, 99315-99316, 99341-99345, 99347-99350 (all with an indicator of 1) and eye exam codes 92002-92014 (all with a 0 indicator) because the glaucoma screening and an ophthalmic evaluation are not payable on the same day.
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