Optometry Coding & Billing Alert

Question: A patient with controlled type II diabetes and a family history of visual loss reports to the optometrist for a screening. The patient's medical record confirms that he has never had a glaucoma screening before. How should we code the procedure for Medicare?

California Subscriber

Answer: This patient is eligible for a covered Medicare screening. Use the following codes for the procedure:

- G0117 (Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist) for the screening

- V80.1 (Special screening for neurological, eye and ear diseases; glaucoma) to show why you are conducting the test

- 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled) for the patient's diabetes

- V19.0 (Family history of blindness or visual loss) to represent the family history of glaucoma.

Code G0117 is for services the doctor provides. You should use G0118 (Glaucoma screening for high- risk patients furnished under the direct supervision of an optometrist or ophthalmologist) if the optometrist supervises the screening instead.