Ophthalmology and Optometry Coding Alert

Medicare and most commercial insurances cover annual glaucoma screenings for high-risk individuals. These include: patients with diabetes individuals with a family history of glaucoma Hispanics 65 and older African-Americans 50 and older. While these are the groups that the Medicare glaucoma screening codes G0117 and G0118 are targeting, most but not all of this group will probably have other ocular complaints or problems that will justify a complete exam which will include all the components of a glaucoma screening exam. "Medicare criteria is specific when it comes to the specific circumstances for coverage of the glaucoma screening G codes and documentation would need to be supportive of screening policies when reporting these codes," warns Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, Director, Best Practices-Network Operations at Mount Sinai Hospital in New York City. "Patients with co-morbidities will typically require a more comprehensive evaluation and the service will be more [...]