" Ophthalmologists initially welcomed Medicare's decision to cover glaucoma screening effective Jan. 1, 2002. However, using these codes requires understanding the limitations of G0117 (Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist) and G0118 (Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist).
Codes G0117 and G0118 include a dilated examination (DE), intraocular pressure measurement, a test for visual acuity, and direct ophthalmoscopy or a slit-lamp biomicroscopic exam, says Ann Rose, president of Rose and Associates, an ophthalmology coding and compliance consultancy based in Duncanville, Texas.
The
Correct Coding Initiative (CCI, Version 8.0) bundles G0117 and G0118 with E/M services (99201-99215, 99241-99245, 99301-99303, 99311-99313, 99315-99316, 99321-99323, 99331-99333, 99341-99345, 99347-99350, all with a modifier indicator of 1) and eye exam codes (92002-92014, all with a 0 modifier) because the glaucoma screening is valued to include the exam. The following codes are also bundled with glaucoma screening: 92100 (Serial tonometry [separate procedure] with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day [e.g., diurnal curve or medical treatment of acute elevation of intraocular pressure]), 92120 (Tonography with interpretation and report, recording indentation tonometer method or perilimbal suction method), 92130 (Tonography with water provocation) and 92140 (Provocative tests for glaucoma, with interpretation and report, without tonography).
Medicare accepts only one diagnosis code, V80.1 (Special screening for neurological, eye, and ear diseases; glaucoma), for G0117 and G0118.
The unadjusted reimbursement for G0117 is about $52.13 when performed in the office.
G0118 Limitations
Because technicians are not qualified to perform the DE component, it is unlikely that G0118 will be used, Rose says. A physician must perform a dilated examination.""
Use G0118 with caution. Some payers suggest that G0118 violates state laws because only an optometrist or ophthalmologist is licensed by the state to perform a DE. Theoretically" however a physician could perform the DE and a technician could perform the rest of the screening but Rose says this is unlikely.
Who Is Covered
Only high-risk patients are eligible for this benefit: those with a family history of glaucoma those with diabetes mellitus and African-Americans over age 50. Before scheduling a Medicare patient for glaucoma screening make sure the patient is eligible; if not he or she will be responsible for the charge. If the patient is ineligible and the ophthalmologist bills Medicare as though the patient were this would be billing for a noncovered service as if covered which is fraud.
When patients call for an appointment for the "free" glaucoma screening (as with all Medicare services the patient must pay a 20 percent copayment) the front desk should say "Yes Medicare now offers a glaucoma [...]
