Wiki Glaucoma Screening

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cjlamm

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I have an Optometrist who spreads the glaucoma screeding over two + visits. The OCT will be done with an exam and then another appointment scheduled for an IOP, etc. I'm not sure how to justify the services. Documentation will include "slightly large optic nerve cup-to-disc ratio" and then "normal routine ophth exam". My understanding is that I can't use V80.1 until the screening is complete. I can't use 377.14 because the documentation states "normal" exam. There is no pers or fa history that I can fall back on for a dx code. Pt is 36 yo so age isn't really a factor. CC: Glaucoma suspect screening. Thanks for any guidance you can provide

Illinois Grandma
 
I would use the V72.0 for Routine Annual Eye Exam and the glaucoma suspect code for the OCT procedure to support MN (per the documentation). I would educate your provider NOT to split up those visits and bring the patient back just for an IOP check. (As an auditor, thats a red flag for me) The IOP is part of the annual exam and definitely should be performed and documented if you are billing 92014 or 92004 codes.

As far as the IOP check, that is ok for glaucoma suspect, however if that is all that is done, then you would ONLY bill 99211. Just make sure the technician or nurse is documenting everything about the IOP check AND that the provider was an order in the chart for a return visit for the IOP before its performed.

I hope this clarifies everything for you.
 
If you are billing Medicare than you would use G0117 (done by optometrist) or G0118 (performed by ancillary staff). I believe you can NOT use those G codes on the same day as Exams, because of bundling due to NCCI edits.
 
mzkandy83 said:
I would use the V72.0 for Routine Annual Eye Exam and the glaucoma suspect code for the OCT procedure to support MN (per the documentation). I would educate your provider NOT to split up those visits and bring the patient back just for an IOP check. (As an auditor, thats a red flag for me) The IOP is part of the annual exam and definitely should be performed and documented if you are billing 92014 or 92004 codes.

As far as the IOP check, that is ok for glaucoma suspect, however if that is all that is done, then you would ONLY bill 99211. Just make sure the technician or nurse is documenting everything about the IOP check AND that the provider was an order in the chart for a return visit for the IOP before its performed.

I hope this clarifies everything for you.
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A glaucoma screening is not the same glaucoma suspect. A glaucoma suspect is a patient that already has a low level of increased pressure and is being monitored for this, a screening is an a symptomatic patient that meets certain criteria that makes it prudent to perform a screening test. Therefore the V code for screening is the appropriate code. If the screening is split into 2 encounters then thenV code would need to be coded twice however I too recommend that this all be done at the same encounter, I would not use the 99211 for this, use the screening G codes.
 
No, the glaucoma screening is not for glaucoma suspect. But the patients status in this case (If I read correctly) is glaucoma suspect. It is possible for the provider to bring the patient back in for IOP check. If you are ONLY bringing the patient back for an IOP check, and its performed by ancillary staff, you would then bill the 99211.

The practice I managed, sees this allday everyday. As long as my providers have an order in the patients record to bring them back for an IOP check, that Level 1 E&M is billable.....Otherwise, you can NOT bill a Glaucoma screening at the same time as the Ophthalmology E&M codes, nor on a return visit just for IOP check. There needs to be a full work-up to bill glaucoma screening.
 
The 99211 is to be ONLY used if the physician orders a IOP check and its done without the provider seeing the patient face to face (performed by technician)on a separate visit.

However, per CMS guidelines, the G0117 or G0118 needs to reflect that the patient is high risk AND the screenings were performed AND that the patient was dilated. Basically your patient can't refuse because CMS looks at it as the patient is a risk so it needs to be done to support MN.

I apologize, but I audited for RAC in my region, specifically in Optometry/Ophthalmology.
 
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