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. Plaquenil side effects heart Chloroquine resistant malaria cdc Proguanil plus chloroquine Natural substitute for chloroquine 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. A maximum of 10 doses per vial is allowed for Medicare billing, even if more than ten preparations are obtained from the vial. In cases where a multidose vial is diluted, Medicare should not be billed for diluted preparations in excess of the 10 doses per vial allowed under code 95165. 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 Macular degeneration tests & treatment - Medicare.gov, Billing and Coding Guidelines for Allergy Testing. Plaquenil dose for sjogrensHydroxychloroquine to treat hair lossCan i drink alcohol while taking plaquenil 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. E&M or Eye Code Which to Choose? - American Academy of.. CPT code 92133, 92134 - SCODI Medicare Payment.. Ocular complications of chloroquine and derivatives therapy.. While this is an exciting development in ophthalmologic care, current mfERG use is not widespread and its future role in hydroxychloroquine retinopathy screening is not fully understood. It seems unlikely that mfERG will replace visual field testing, and adding mfERG to screening protocols may result in greater overall costs. 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 A 26-year-old black female presented in office for her annual comprehensive eye exam. Her medical history was significant for Plaquenil therapy spanning 12 years with a daily dose of 200mg twice daily. She presented with a best-corrected visual acuity of 20/20 OD and 20/20 OS. All preliminary testing revealed normal findings.