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. Effect of chloroquine injection Plaquenil elimination half life Trental and plaquenil together Why chloroquine While this is an exciting development in ophthalmologic care, current mfERG use is not widespread and its future role in hydroxychloroquine retinopathy screening is not fully understood. It seems unlikely that mfERG will replace visual field testing, and adding mfERG to screening protocols may result in greater overall costs. 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. Ocular Examination Ocular examination took place where possible before therapy was begun; it was repeated after approximately 10 months and then at four-monthly intervals. It comprised 1 The recording of visual acuity. 2 The assessment of colour vision by means of the Ishihara pseudoisochromatic plates. 3 The recording of central fields on the tangent screen to a 1-mm. white and a 7.5. 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 Billing and Coding Guidelines Title, How to Succeed in Plaquenil Screenings Chloroquine and cancerSaposin b binds chloroquineChloroquine dosing scheduleHydroxychloroquine price in india Glaucoma is a leading cause of blindness, and a disease for which treatment methods clearly are available and in common use. Glaucoma also is diagnostically challenging. Almost 50% of glaucoma cases remain undetected. Elevated intraocular pressure is a clear risk factor for glaucoma. CPT code 92133, 92134 - SCODI Medicare Payment.. Chloroquine Ophthalmological Safety, Clinical Assessment.. To bill for diagnostic tests, understand these three modifiers. Eye code 92012. Most non-Medicare payers have higher allowables for E&M codes. In this example, our commercial payer allowable is higher for the E&M code than the Eye code, so you would bill 99213. Diagnosis Can Affect Code. Have staff clearly indicate in the documentation why the patient presented for the examination; this can affect code. Test, and canalith repositioning procedures; thus, laboratory-based vestibular function testing does not add diagnostic information in such routine cases. The evidence is sufficient to determine that the technology is unlikely to improve the net health outcome. Oct 01, 2018 Patients in whom Chloroquine or hydroxyChloroquine have failed to prevent or cure clinical malaria or parasitemia, or patients who acquired malaria in a geographic area where Chloroquine resistance is known to occur should be treated with another form of antimalarial therapy see WARNINGS and INDICATIONS AND USAGE, Limitations of Use.