So Is Your Glaucoma Patient Truly At High Risk?

By Author: erinarticle
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Medicare and most commercial insurances cover annual glaucoma screenings for high-risk individuals which include patients with diabetes, individuals with a family history of glaucoma, hispanics 65 and older, and African-Americans 50 and older.


While these are the groups that the Medicare glaucoma screening codes G0117 and G0118 are focusing on, most but not all of this group will most likely 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 while reporting these codes. Patients with co-morbidities will normally require a more comprehensive evaluation and the service will be more than just glaucoma screening; thus resulting in an E/M or eye code for reporting.


Here's an example: A patient with diabetes will most probably be undergoing a full ophthalmic exam to determine the presence of any ...
... diabetic retinopathy or other disorders, including glaucoma. These encounters would be considered medically necessary E/M exams and submitted with the proper diabetes ICD-9 code (like 250.0x, Diabetes mellitus without mention of complication). Even though eye codes may be assigned instead of E/M codes, my personal recommendation is to make use of E/M codes when a patient presents with pathology and only assign eye codes for patients without chronic diseases or illnesses.


For more on Medicare's glaucoma screening guidance and for other specialty-specific articles to assist your ophthalmology coding, sign up for a good medical coding resource like Coding Institute.