Optometry Coding & Billing Alert

Published on Mon Apr 03, 2006 PDF

Tip:  Use underlying condition as secondary diagnosis

When you-re checking a patient's eyes for the harmful effects of Plaquenil, make sure you know whether the patient is still taking the drug--and what for--if you want the insurance carrier to honor your claim.

Plaquenil is the trade name for hydroxy-chloroquine, a medication used to treat rheumatoid arthritis and lupus. The drug can harm the lens and retina of the eye. Primary-care physicians often refer a patient to an optometrist to perform visual fields (92081-92083, Visual field examination, unilateral or bilateral, with interpretation and report ...) for monitoring possible ocular changes.

The diagnosis coding depends on whether the patient is now taking Plaquenil. For your primary diagnosis, if the patient has completed his course of treatment of the drug, use ICD9 V67.51 (Follow-up examination; following completed treatment with high-risk medications, not elsewhere classified). If the patient is still being treated with the drug, use V58.69 (Long-term [current] use of other medications).

For your secondary diagnosis, you must code the reason the patient is on Plaquenil--the underlying condition, most typically lupus (710.0) or rheumatoid arthritis (714.0), says Charles Wimbish, OD, president of Wimbish Consulting Group in Martinsville, Va.