Ophthalmology and Optometry Coding Alert

Question: A Medicare patient presented for a glaucoma screening. He had no personal history or diagnosis of glaucoma, but due to his age, race, and family history was considered at risk for glaucoma. What should I report for this visit?

Nebraska Subscriber

Answer: Report G0117 (Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist) or G0118 (… furnished under the direct supervision of an optometrist or ophthalmologist), depending on whether your ophthalmologist performed the screening himself, or supervised the performance of it.

This is not a routine exam but is considered a screening exam, as the patient meets the criteria for early glaucoma screening and is concerned about the health of their eyes without any current symptoms.

V-code benefit: For a screening, report G0117 or G0118 with ICD-9 code V80.1 (Special screening for neurological, eye, and ear diseases; glaucoma). You should still report the “V” code as your primary code for a patient who presents for glaucoma screening if glaucoma is found. Report code 365.x (Glaucoma) as your secondary diagnosis if the ophthalmologist finds glaucoma during the exam.

ICD-10: Starting Oct. 1, 2015, report Z13.5 (Encounter for screening for eye and ear disorders) instead of V80.1. Report the appropriate code from the H40-H42 (Glaucoma) ICD-10 code series if the ophthalmologist finds glaucoma during the exam.

Keep in mind that the correct “G’ code to report depends upon who performed the screening. When reporting the service performed by an ophthalmic tech, (G0118), the ophthalmologist or optometrist must provide supervision.

Don’t miss: Remember that Medicare-only G codes are bundled with E/M and eye codes. It would be rare for a patient to report to your office for the purpose of a glaucoma screening only, experts note. Therefore, your physician is more likely to perform a complete ophthalmic evaluation which may include glaucoma screening and should be coded with the appropriate level of E/M or eye code.