Coding and Billing

Glaucoma Screening Codes to Enhance Reimbursements

By Mark Wright, OD, FCOVD,
and Carole Burns, OD,FCOVD

August 1, 2018

There is more to coding for glaucoma care than you may realize.

Sometimes a Medicare patient will show in your office without a medical reason for the examination. If the patient has not been diagnosed with glaucoma, and meets one of the four criteria for use of the glaucoma screening codes, then you can use either G0117 or G0118 to bill for that day’s visit.

The four criteria are:
• Individuals with diabetes mellitus
• Individuals with a family history of glaucoma
• African-Americans age 50 and over
• Hispanic-Americans age 65 and over

The glaucoma screening codes are defined as:
• G0117 (Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist)
• G0118 (Glaucoma screening for high-risk patients furnished under the direct supervision of an optometrist or ophthalmologist).

There is an important difference between the two codes. For code G0117, the physician performs the service. For code G0118, the service is provided under the direct supervision of the physician. Direct supervision means the physician is immediately available to direct and assist in the performance of the procedure if necessary. Direct supervision means the physician must be in the practice, not necessarily in the room where the test is being done.

There are three levels of supervision:
• General Supervision – the ECP does not have to be on the premises.
• Direct Supervision – the ECP must be in the office.
• Personal Supervision – the ECP must be present in the room.

The two codes G0117 and G0118 can only be billed once a year. It’s important to know that Medicare defines a year as 11 months.

Once the diagnosis of glaucoma occurs, use of the codes G0117 and G0118 are no longer appropriate. For every medical office visit related to glaucoma after the diagnosis has been established, the General Ophthalmological Exam codes (92012, 92014) or the Evaluation and Management (99212-99215) office exam visit codes should be used.

If the patient is in your office for any medical reason, be aware that the Correct Coding Initiative (CCI) bundles the glaucoma screening codes into both the 92000 eye exam codes and the 99000 E/M codes.

The tests associated with codes G0117 and G0118 are:
• visual acuity
• dilated examination
• intraocular pressure measurement
• direct ophthalmoscopy or a slit-lamp exam

Because technicians are not qualified to perform the dilated examination component, the use of code G0118 becomes problematic. A physician must perform the dilated examination. Theoretically, a physician could perform the dilated fundus examination, and a technician could perform the rest of the screening, but this must be clearly documented in the exam notes.

Sometimes there is a difference between state laws regulating the practice of optometry and coding definitions. State laws dictate who can legally perform glaucoma screenings. You should always follow your state laws even though coding definitions may allow something different.

It is interesting to note that visual fields (92081-92083) are not bundled with the glaucoma screening codes. If your screening findings indicate glaucoma, and you want additional testing to confirm your suspicion, from a coding standpoint, it is best to schedule the patient back on a different day for a complete glaucoma workup.

One last point is: do not advertise the use of the glaucoma screening codes as a “free glaucoma screening.” As with all Medicare eyecare services, deductibles and co-pays must be collected. You cannot routinely waive deductibles and co-pays for Medicare patients.

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