This article is more than 5 years old. Information may no longer be current.
Glaucoma screening exam
Medicare has specific requirements for covering annual screening.
A patient presents for an annual cataract check for incipient cataracts. The patient’s history sheet shows that his mother had glaucoma. As part of a dilated comprehensive eye examination, the patient’s IOP is checked, a fundus examination is performed and the anterior chamber is examined. His pressure is found to be within normal limits, angles are open and the optic nerve and disc are healthy and pink. The patient’s cataracts have not progressed, but he requires new glasses to correct his vision. The physician recommends a return in 1 year for a cataract check.
Six months later, the patient calls the office indicating he read in “Modern Maturity” that Medicare covers an eye examination for glaucoma screening. Because his mother had glaucoma, the patient asks to be scheduled for a glaucoma screening examination.
Medicare covers an annual glaucoma screening examination for patients with diabetes mellitus, patients who have a family history of glaucoma and African-Americans age 50 and over who are Medicare-eligible. The procedure code is Glaucoma screening furnished by an optometrist or ophthalmologist (G0117). The diagnosis code is V80.1, Special screening for neurological, eye and ear diseases; glaucoma. Screening examinations submitted with any other diagnosis will be automatically denied.
Medicare defines the term “screening for glaucoma” as (1) a dilated eye examination with an intraocular pressure measurement, and (2) a direct ophthalmoscopy or a slit-lamp examination. The glaucoma screening examination cannot be billed in conjunction with any other examination. In fact, Medicare believes that physicians will more commonly provide glaucoma tests in conjunction with other services, and will rarely provide only glaucoma screening to Medicare patients.
In this scenario, the glaucoma screening benefit would not be allowed because the patient received a glaucoma screening as part of his annual cataract evaluation. If the patient had not received any other glaucoma screening service in the prior 11 months, then this screening examination would be billable to Medicare. To determine the 11-month period, count begins with the month after the month in which the previous covered screening procedure was performed.