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Ophthalmology Coding Alert

Reader Questions:
Try V58.69 for Plaquenil Exam

Question: What diagnosis code should we use for OCT when the patient is currently on Plaquenil but not yet showing signs of macular degeneration, and there is no other diagnosis available that meets the CMS LCD requirements?  Answer: There is probably no way you can get reimbursed for optical coherence tomography (OCT) to check whether a drug a patient is taking is affecting his vision. For a Plaquenil check, the appropriate ICD-9 code would be a V code such as V58.69 (Long-term [current] use of other medications), with the patient's systemic condition -- the reason he's taking the drug, such as (714.x, Rheumatoid arthritis and other inflammatory polyarthropathies) -- as a secondary diagnosis. But those diagnosis codes are not on most carriers' lists of approved ICD- 9 codes for 92133-92134 (Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; ...). Why not? Payers are apparently not convinced [...]


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