• Correct diagnosis for a Plaquenil exam


    Question: I have heard conflicting information regarding the correct diagnosis for a Plaquenil exam. Should I use high-risk medication as my primary code?

    Answer: When billing Plaquenil examinations, or any other high risk medication exams, it is appropriate to bill the systemic disease or any ocular manifestations as the primary diagnosis since many payers may not reimburse for the high-risk medication diagnosis as a stand-alone diagnosis. Testing services performed should have the high-risk medication diagnosis as the primary diagnosis since that is the reason for the testing..