Ophthalmology and Optometry Coding Alert

Question: Which codes (diagnosis and CPT) should we use for baseline Plaquenil exams?
      
Ohio Subscriber
 
Answer: Plaquenil is the trade name for hydroxychloroquine, a medication used to treat rheumatoid arthritis and lupus. It can have adverse effects on the lens and/or retina and, therefore, the primary-care physician or rheumatologist treating the condition refers the patient to an ophthalmologist for monitoring ocular changes. Use either an E/M office visit code (99xxx) or an eye code (92xxx). It may also be necessary to check visual fields using 92082 (intermediate examination) or 92083 (extended examination). 
 
You may need to perform an extended ophthalmoscopy (EO). However, some carriers will not pay for 92225 (ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial) with the diagnosis code for Plaquenil monitoring, which is either V58.69 (long-term [current]  use of other medications) or V67.51 (follow-up examination [surveillance only following completed treatment] with high-risk medications, not elsewhere classified). In those cases, include the EO in the E/M office visit or eye code, and code according to the total service rendered and documented in the visit, as well as the visual field code. The diagnosis codes depend on whether the patient is now taking Plaquenil. If the patient has used the drug in the past but is no longer using it, code V67.51. You may need to conduct several checks after medication has discontinued to make sure latent toxicity doesn't appear.
 
If the patient is taking the drug, use V58.69 (long-term [current] use of other medications); a few carriers, however, prefer V80.2 (special screening for other eye conditions). To be paid for the visit and the visual fields, use the specific diagnosis code recommended by the carrier in its LMRP. The underlying condition may be coded as a secondary diagnosis. Some carriers prefer the underlying diagnosis to be coded as the primary diagnosis, and the V code for the high-risk medication as the secondary diagnosis. The upshot is  follow your carrier's LMRP instructions.
 
-- Reader Questions and You Be the Coder were answered by Raequell Duran, president, Practice Solutions, ophthalmology coding and compliance consultancy, Santa Barbara, Calif.; Lise Roberts, vice president, Health Care Compliance Strategies, Jericho, N.Y.; and Deborah Rogers, COT, Andersen Eye Associates, Saginaw, Mich.