Ophthalmology and Optometry Coding Alert

Question: When the ophthalmologist performs OCT on a patient using Plaquenil for rheumatoid arthritis to check for ophthalmic side effects, what diagnosis codes should I report?

Nebraska Subscriber

Answer: 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 ophthalmologist to perform tests such as optical coherence tomography (92134, Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina) for monitoring possible ocular changes.

The diagnosis coding depends on whether the patient is now taking Plaquenil. For your primary diagnosis, most carriers want you to code the reason the patient is on Plaquenil – the underlying condition, in this case rheumatoid arthritis (714.0).

For the secondary diagnosis, if the patient has completed his course of treatment of the drug, use ICD-9 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).

If the patient has symptoms or findings with the examination, code first the symptoms/findings, then the underlying reason for the Plaquenil therapy and the appropriate V code as indicated above.

ICD-10: After Oct. 1, 2015, if the patient has completed the course of treatment, report ICD-10 code Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm) instead of V67.51. If the patient is still being treated, report Z79.899 (Other long term [current] drug therapy) in place of V58.69.

Some payers also want you to report the E code E931.4 (Antimalarials and drugs acting on other blood protozoa) to identify the drug.