Her rheumatologist instructed her to undergo a baseline ocular examination prior to initiating Plaquenil (hydroxychloroquine, Sanofi-Aventis) therapy. Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. Although the incidence of macular toxicity is infrequent with Plaquenil use (at a dosage of 200mg or 400mg q.d.), its visual impact can be devastating. How good is plaquenil for diabetes Plaquenil and methotrexate together Eye code 92012. Most non-Medicare payers have higher allowables for E&M codes. In this example, our commercial payer allowable is higher for the E&M code than the Eye code, so you would bill 99213. Diagnosis Can Affect Code. Have staff clearly indicate in the documentation why the patient presented for the examination; this can affect code. Macular degeneration is diagnosed by an eye test. While Medicare doesn’t cover routine vision exams, beneficiaries may be covered for certain preventive and diagnostic exams to treat eye conditions. If you think you may have macular degeneration, check with your doctor. Medicare may cover an exam to diagnose macular degeneration. Glaucoma is a leading cause of blindness, and a disease for which treatment methods clearly are available and in common use. Glaucoma also is diagnostically challenging. Almost 50% of glaucoma cases remain undetected. Elevated intraocular pressure is a clear risk factor for glaucoma. Initially, central visual acuity may be unaffected, but the patient may notice related paracentral scotomas that often interfere with reading. The associated classic retinal toxicity is described as a bull’s eye maculopathy (ring of depigmented retinal pigment epithelium that spares the foveal area). Medicare allowable ocular testing for chloroquine therapy To bill for diagnostic tests, understand these three modifiers, Macular Degeneration Treatment & Medicare Coverage Plaquenil and heartPlaquenil difficulty sleepingChloroquine phosphate overdoseHydroxychloroquine thrombocytopenia side effects Ophthalmologic Considerations and Testing in Patients Receiving Long-Term Antimalarial Therapy HOWARD N. BERNSTEIN, M. D. Bethesda, Maryland From the Sub-Section of Ophthalmology, Subur- ban Hospital, Bethesda, Maryland, and the Oph- thalmology Department, Washington Hospital Center, Washington, D. C. Requests for reprints should be addressed to Dr. Howard N. Bernstein, 11404 Old Georgetown Road. Ophthalmologic considerations and testing in patients.. CPT code 92133, 92134 - SCODI Medicare Payment.. CHLOROQUINE PHOSPHATE, USP. These annual examinations should include a thorough ocular exam, automated 10-2 visual fields, and 1 or more of the recommended objective tests. Visual field testing and objective tests are able to detect retinal changes before damage can be seen via fundus photography or dilated fundus exams. 5-7 Chloroquine and hydroxychloroquine belong to the quinolone family. They are related drugs with similar clinical indications for use and similar manifestations of retinal toxicity, although their therapeutic and toxic doses differ. CONCLUSION All patients using chloroquine and its derivatives must be followed-up and documented since the beginning of the therapy until they reach a cumulative dose above 100 grams. The higher the cumulative dose, the more we must be concerned with patient follow-up.