Optometry Coding & Billing Alert
Add 4th Criterion for Glaucoma Screening Candidates in 2006
CMS may add Hispanics 65 and older to the list of those eligible for G0117 The patient must also already be a Medicare beneficiary.
Last month, we gave you advice on proper coding and billing for glaucoma screenings ("Reduce Your Risk of Improperly Coding Glaucoma Screenings," Optometry Coding & Billing Alert, August 2005). Next year you may have to ask one more question when determining whether a patient is eligible for a Medicare-covered glaucoma screening: "Are you a Hispanic age 65 or older?"
Medicare wants to add that criterion to the list of high-risk indicators that qualify a patient for a glaucoma screening, 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). The glaucoma screening is now only for high-risk patients, says Cornelia Chavis, billing and insurance manager at Raeford Eye Associates in Raeford, N.C. Medicare now defines "high-risk" patients, Chavis says, as:
Recent studies on the prevalence of glaucoma that separated data for Hispanic persons found that "Hispanic subjects had a marked higher prevalence in the oldest age group," according to the proposed rule, found in the Aug. 8, 2005, Federal Register. "The prevalence of open angle glaucoma in Hispanic persons age 65 years and older was significantly higher than among whites."
If Medicare adopts this proposal in the final rule, then effective Jan. 1, 2006, "Hispanic Americans age 65 and older would qualify for Medicare coverage and payment for glaucoma screening services," the proposed rule says.
Note: For more on properly coding glaucoma screenings, see "Reduce Your Risk of Improperly Coding Glaucoma Screenings" in the August 2005 Optometry Coding & Billing Alert.
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