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Shane Posted Mon 05th of August, 2013 21:48:46 PM

What are the current G-codes for Medicare claims used in Optometry?

SuperCoder Answered Tue 06th of August, 2013 22:25:46 PM

The G codes are rarely used, but are available if applicable. G0117 would be the code used by optometrists. It consists of visual acuity, IOP measurement and a dilated fundus examination.

G0117: Glaucoma screening for high-risk patient furnished by physician
G0118: Glaucoma screening for high-risk patient furnished under direct physician supervision

You have two coding options for reporting glaucoma screenings to Medicare:

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).

Caution: Remember that using code G0117 or G0118 means you're unable to report several other services. If any other item (an exam or any diagnostic tests like a visual field) is billed on the same day as the screening, the screening will bundle into that code and will not be paid separately.

Codes G0117 and G0118 both include a dilated examination (DE), intraocular pressure (IOP) measurement, a test for visual acuity, and direct ophthalmoscopy or a slit-lamp biomicroscopic exam.

The National Correct Coding Initiative bundles G0117 and G0118 with E/M services 99201-99215, 99241-99245, 99315-99316, 99341-99345, 99347-99350 (all with an indicator of 1) and eye exam codes 92002-92014 (all with a 0 indicator) because the glaucoma screening and an ophthalmic evaluation are not payable on the same day.

Remember: A 0 indicator means that you may not unbundle the edit combination under any circumstances, according to NCCI guidelines. An indicator of 1 means that you may use a modifier to override the edit if the procedures are distinct from one another, such as on a separate encounter on the same date, on a separate anatomical site, or for a separate indication, explains Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, director of Best Practices-Network Operations at Mount Sinai Hospital in New York City.

You also can't report the following codes with a 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).

Tip: You cannot report another office visit or consultation for a patient on the same day you're reporting the glaucoma screening. When your optometrist diagnoses or suspects glaucoma, you may want to report an E/M code instead of the glaucoma screening code if the provider documented all of the elements for reporting an E/M service. This allows the provider to order and perform diagnostic tests at this same session. Medicare allows around $46 for the glaucoma screening, compared with $135 for a 92004 or $110 for a 92014.

If, after a finding of glaucoma, the provider decides to perform a complete evaluation and management service at the same encounter, then the glaucoma screening is included in the work performed for the E/M code and not separately reportable.

Note: Payers other than Medicare don't recognize G0117 and G0118. Check with your individual payers on how they want you to report glaucoma screenings and if they will even pay for them.

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