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. Does hydroxychloroquine thin the blood Chloroquine treatment of cells Hydroxychloroquine sulfate rash The use of this modifier is connected to the issue of whether a given diagnostic test is considered unilateral or bilateral by Medicare. Unilateral tests are those that have each eye paid. 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. They will also automatically receive 100% of Medicare reimbursement. This is both good and bad for the provider, as fortunately they do not have to perform or report any measures but they are not eligible to receive any incentive payments in addition to the Medicare allowable. 4. Know Proper Optometry Billing and Coding Procedures 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 CPT code 92133, 92134 - SCODI Medicare Payment., Billing and Coding Guidelines for Allergy Testing. Hydroxychloroquine pancreatic cancer 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. Macular Degeneration Treatment & Medicare Coverage. The Ultimate Guide to Optometry Billing and Coding.. Spotlight Case Chloroquine - The American Society of Retina.. Medicare doesn’t cover eye exams sometimes called “eye refractions” for eyeglasses or contact lenses. Your costs in Original Medicare You pay 100% for eye exams for eyeglasses or contact lenses. Annual ocular toxicity screening is recommended to begin only after 5 years of use unless patients are considered high-risk or develop ophthalmologic symptoms. Amsler grids are no longer appropriate for screening. Appropriate ocular toxicity testing should include 10–2 visual field testing and spectral domain ocular coherence tomography. 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.