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. Plaquenil positive reviews Plaquenil 200 mg tablets side effects Plaquenil brittle hair Hydroxychloroquine and iron supplements 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. 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. AMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT. and over the duration of therapy to allow for early. Effects of Hydroxychloroquine and Chloroquine on the. 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 Chloroquine and Hydroxychloroquine Toxicity Treatment., To bill for diagnostic tests, understand these three modifiers What painkillers can i take with hydroxychloroquine 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. Routine Eye Exam Coverage - Medicare.gov. AMERICAN COLLEGE OF RHEUMATOLOGY. Chloroquine - FDA prescribing information, side effects and uses. The CY 2019 Medicare Physician Fee Schedule Proposed Rule with comment period was placed on display at the Federal Register on July 12, 2018. This proposed rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule PFS on or after Jan. 1, 2019. 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. Ophthalmologic Considerations and Testing in Patients Receiving Long-Term Antimalarial Therapy HOWARD N. BERNSTEIN, M. D. Bethesda, Maryland From the Sub-Section of Ophthalmology, Subur- ban Hospital, Bethesda, Maryland, and the Oph- thalmology Department, Washington Hospital Center, Washington, D. C. Requests for reprints should be addressed to Dr. Howard N. Bernstein, 11404 Old Georgetown Road.