Visual Fields and Plaquenil

chelseasmith

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I work in an ophthalmology office. Plaquenil is often prescribed to our pt's for arthritis, which can affect the field of vision. When I send the claim billed as 92083 (HVF) with the Dx Z79.899 (High risk meds), if often comes back denied. Any suggestions on how to get the HVF covered with use of Plaquenil?
thanks!!
 

briansmith99

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Our office has been including a second diagnosis for the disease related to Plaquenil use. We aren't seeing denials using that method but from a coding standpoint I don't know if that is a 'more correct' coding or if we are just billing different insurances and getting different responses regardless of our using a second dx code. Have denials come with a uniform reason?
 

Cheezum51

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You need to code first for the condition being treated with the Plaquenil, such as Lupus or rheumatoid arthritis, and the second code is the Z code you use. If there is any toxicity found, you have to get that code from the Drugs and Chemicals section and put that third with an "A" for initial time that's noted.

Tom Cheezum, O.D., CPC
 

chelseasmith

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You need to code first for the condition being treated with the Plaquenil, such as Lupus or rheumatoid arthritis, and the second code is the Z code you use. If there is any toxicity found, you have to get that code from the Drugs and Chemicals section and put that third with an "A" for initial time that's noted.

Tom Cheezum, O.D., CPC

Thank you for your reply! should the code from the "drug and chemical" section take place of he Z code?, or should that be the 3rd code?
 

drakena74

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I would think you would need to add the drug with the other dx coding as well, telling the insurance that this is the high risk drug pt is taking. adverse effect of Plaquinil (Hydroxychloroquine) T37.8x5A. We did this in I-9, but it was listed under therapeutic. :confused:
 

Cheezum51

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For situations where no drug toxicity is found, you code:
1) Condition being treated
2) Z code for long term use

If there is drug toxicity found, and this is the first time you're seeing it, you code:
1) Condition being treated
2) Z code for long term use
3) List the code for the drug adverse effect (hydroxychloroquine) with an "A"

Tom Cheezum, O.D., CPC
 

CBP2014

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I recently had a denial for VF with Z79.899 that a screening code was needed by that payer. I believe Z13.5 would be appropriate with Z79.899 - as there are no manifestations yet:confused:
 

Cheezum51

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Z79.899 is the code recommended by the American Academy of Ophthalmology. You may want to check with the payer to see why they rejected that code.

Even under ICD-9, the "Long term use of medications" code was used for years.

Tom Cheezum, O.D., CPC
 

prentice.linda.m@gmail.com

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I agree with Dr. Tom Cheezum.

You can code for the condition being monitored (Lupus, RA, etc) and the Z79.899 code for long term use. You could also add a screening code if the payer requires it.

You should never use a T code for screening for an adverse effect. T codes would only be used once there is a diagnosed issue caused by the med.

Linda Prentice, OCS, COC-A, CPC-A
 
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