Testing & Billing for Ophthalmic Side Effects – Ophthalmology Management

Plaquenil, and other anti-malarial drugs, may seem to be an odd topic for a column on ophthalmic coding. However, they have found use in treating systemic disease and can have adverse ophthalmic effects. Since these may well show up in your patients, here are the essentials on diagnosis and billing.

This article answers the following questions:

  • What is Plaquenil?
  • Why do ophthalmologists see patients who are on Plaquenil therapy?
  • Do Medicare and other payers cover exams and tests for Plaquenil use?
  • What tests are usually done?
  • I recently read that OCT testing is now indicated for Plaquenil patients. Will payers cover this testing?
  • What diagnoses should I use for the exam and testing?
  • If Plaquenil is planned but not yet started, is the exam covered?

This article was published in Ophthalmology Management’s Coding & Reimbursement column, which is written by Corcoran’s Executive Vice-President, Suzanne Corcoran, COE. To view the entire article in Ophthalmology Management, click on the link below:


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