Glaucoma Screenings: S0620 Or G0117 -which Code To Go For?

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With more than 18 choices to sift through when coding a glaucoma visit, you need these simple guidelines to secure the insurer preferred code that lands payment, and not denial.


You have four choices for coding glaucoma exams, depending on the payer, type and severity of the glaucoma. You're provided an option of using four ophthalmic visit or CPT codes, 10 evaluation and management (E/M) codes, two HCPCS S codes (S0620 and S0621, Routine ophthalmological examination including refraction ...) and two G codes or most likely a combination of these.


Trap: According to experts, you can't use any combination of these on the same day. In coding any patient/physician encounter, your main goal is to bill a code that reflects the type of chief patient complaints or reason for the office visit, and the amount and difficulty of the work carried out by the doctor.


Use S codes for routine exams
S0620 and S0621: If a glaucoma patient comes to an ophthalmologist's office for a check-up and has no complaints about his eyes, then this is a routine exam, irrespective ...
... of what the ophthalmologist finds wrong with the patient. If the patient had no complaints, no matter how minor the exam is considered routine. S codes can't be reported to Medicare and are normally codes particular to BC/BS payers. But then BC/BS must also accept the 'eye' codes and E/M CPT codes.


Code routine exams with the HCPCS S codes. A routine exam that uncovers cataracts or pressures in the 40s is still routine if the patient had no complaints, concerns or previous diagnoses of significant eye problems. But then you should list the diagnoses as secondary on the claim form.


For Medicare exams, go to G codes
For Medicare patients, use Medicare's G codes for patients with no personal history or diagnosis of glaucoma, however because of the patient's age, race and family history are thought to be risky for glaucoma.


This is not a routine exam, but is considered a screening exam as the patient meets the criteria for early glaucoma screening and is worried about the health of their eyes prior to any present symptoms.


V code advantage: For a screening, code G0117 or G0118 with ICD-9 code V80.1. You should still code the 'V' code as your primary code for a patient who presents for glaucoma screening if glaucoma is found. Code 365.x (Glaucoma) as your secondary diagnosis if the ophthalmologist finds glaucoma during the exam.


Remember that the proper 'G' code to use depends upon who carried out the screening. When reporting the service carried out by an ophthalmic tech, (G0118), the ophthalmologist or optometrist must provide supervision.


Do not miss: Remember that Medicare G codes are bundled with E/M and eye codes. It would be uncommon for a patient to report to your office for the purpose of a glaucoma screening only. As such, your doctor is more likely to carry out a complete ophthalmic evaluation which may include glaucoma screening and should be coded with the proper level of Evaluation /Management or eye code.


For more on this and for more specialty-specific articles to assist your ophthalmology coding, sign up for a good medical coding resource like Coding Institute.