Article Date: 2/1/2002

Coding Q & A
New Glaucoma Screening Benefit
Reimbursement may be low, but think of the difference you could make by screening more patients.
BY SUZANNE L. CORCORAN, C.O.E.

Q: What's this new glaucoma screening benefit we keep hearing about?

Answer: The Benefits Improvements and Protection Act (BIPA) of 2000 provides annual coverage for glaucoma screening of eligible Medicare beneficiaries, beginning with services provided on or after January 1, 2002. Eligible beneficiaries are patients who are at high risk for glaucoma, defined by Medicare as:

We may see other high-risk categories added later.

BIPA allows for one screening exam per 12-month period. The exam must include a dilated exam with IOP measurement and either a direct ophthalmoscopy exam or a slit lamp biomicroscopic exam.

Only ophthalmologists and optometrists are paid for glaucoma screening exams. As with all services in a medical practice, techs may assist the doctor with part of the exam, but they can't provide the entire exam because they're not licensed to do so.

Q: How do we get paid for this?

Answer: Medicare has assigned a new HCPCS code for the glaucoma screening exam: G0117 (glaucoma screening for high-risk patients, furnished by a physician). It's also specified that it'll only pay for these exams with the diagnosis code V80.1 (special screen for neurological, eye, and ear diseases, glaucoma). Use V80.1 on all of these claims, whether or not glaucoma is diagnosed during the exam.

The national Medicare Physician Fee Schedule allowable amount for G0117 is $52.13. (Local wage indices will adjust this amount.) The usual Medicare co-payments and deductibles apply, and should be covered by supplemental insurance plans, just like other Medicare-covered services.

For non-participating physicians, the national limiting charge for this service is $56.95.

Q: What does it mean for my practice?

Answer: The Glaucoma Research Foundation (GRF) estimates that 3 million Americans have glaucoma, and that only half have been diagnosed. In 1999, ophthalmologists performed 19 million eye exams on Medicare beneficiaries not covered by an HMO; optometrists performed 5 million eye exams. There were 34.5 million Medicare beneficiaries, so at least 30% of them never had an eye exam under Medicare (consider that some patients received multiple eye exams).

At least one million undiagnosed glaucoma patients exist in this elderly population. Reaching out to them could increase practices considerably.

Q: Why provide this service when reimbursement's so low?

Answer: Dismissing the new screening benefit for this reason may be short-sighted. Most patients who come for a screening won't have a regular eye doctor. If the GRF is correct, many of these people have glaucoma (or are glaucoma suspect) and can become regular patients. Some may have other eye diseases that need care. It's a great chance for practice growth.

Offering this service could also have a big impact on public health. This new benefit could save the sight of one million undiagnosed Medicare beneficiaries. It will prompt others to get an eye exam. Offering this service can benefit your practice and country.

SUZANNE L. CORCORAN, COE, IS VICE PRESIDENT OF CORCORAN CONSULTING GROUP. SUE AND HER COLLEAGUES MAY BE REACHED AT (800)399-6565 OR VIA EMAIL AT SCORCORAN@CORCORANCCG.COM.

 


Optometric Management, Issue: February 2002