2018 ICD-10 Update Part 2: Coding for Blindness and Low Vision

Ready for October 1st? Don’t stay in the dark! Our 3-part series covers everything that ophthalmologists, optometrists, and coders need to know about the upcoming changes to ICD-10. If you missed Part 1 of this series, you can read it here.

When Vision Impairment Varies by Eye

Before we dig into the codes, let’s take a look at a new passage in the ICD-10-CM Official Guidelines for Coding and Reporting, which contains general instructions for how to code for blindness and low vision:

“If ‘blindness’ or ‘low vision’ of both eyes is documented but the visual impairment category is not documented, assign code H54.3, Unqualified visual loss, both eyes. If “blindness” or “low vision” in one eye is documented but the visual impairment category is not documented, assign a code from H54.6-, Unqualified visual loss, one eye. If “blindness” or “visual loss” is documented without any information about whether one or both eyes are affected, assign code H54.7, Unspecified visual loss.”

This general guideline helps coders tackle the challenge of both eyes not always having the same ICD-10 code for blindness or low vision. When blindness or low vision isn’t bilateral or isn’t the same category for each eye, you should use your new code options to describe them separately.

Caveat: Even though you have the H54.7 (Unspecified visual loss) code available to you, I strongly discourage you from using it. Payer policies expect a certain level of detail, and they’ll often kick out claims with unspecified laterality.

New Codes Allow You to Report Category of Blindness, Low Vision for Each Eye

Ophthalmology and optometry coders have new codes to work with in the H54 series when describing patients with blindness in both eyes. The new codes allow you to denote whether the right eye blindness is a different category than the left eye blindness. To select the correct code from this series, find the right eye’s category first and then choose the subcode based on the left eye’s category.

Example: If the patient has category 3 blindness of the right eye, you’ll start with new category H54.0X3. Next, you’ll look at the clinical documentation to determine the left eye’s category. ICD-10 offers the following choices:

H54.0X33 — Blindness right eye category 3, blindness left eye category 3

H54.0X34 — Blindness right eye category 3, blindness left eye category 4

H54.0X35 — Blindness right eye category 3, blindness left eye category 5

If you are coding for category the right eye’s category 4 blindness (H54.0X4-) or category 5 blindness (H54.0X5-), you’ll follow a similar logic for coding blindness of the left eye.

Also new for 2018

The ICD-10 manual now allows you to report blindness in one eye with low vision in the other, with categories such as H54.11 (Blindness, right eye, low vision left eye) and H54.12 (Blindness, left eye, low vision right eye), among others. Each category contains subcodes that allow you to report the category of blindness and low vision. For instance:

H54.114 — Blindness right eye category 4, low vision left eye 

  • H54.1141 — Blindness right eye category 4, low vision left eye category 1
  • H54.1142 — Blindness right eye category 4, low vision left eye category 2

Finally, new codes help describe patients with blindness or low vision in one eye and normal vision in the other. For example:

H54.42A3 — Blindness left eye, category 3, normal vision right eye

H54.52A1 — Low vision left eye category 1, normal vision right eye

Want more info about how the ICD-10 updates apply to your eye care practice? Stay tuned for Part 3 of our series, where we’ll cover changes to diabetes and degenerative myopia diagnoses.

To read the complete list of ICD-10-CM changes, go here.

To read the changes to the ICD-10-CM Official Guidelines for Coding and Reporting, click here. Look for the bolded text. The new general guidelines for blindness appear under Chapter 7 on page 43.

Come see us at the American Academy of Ophthalmology’s annual meeting in New Orleans! I’ll be teaching a session called “Strategic Documentation, Compliance, and Revenue Cycle.”

DATE: Monday, November 13th

TIME: 10:15-11:15 AM

LOCATION: Morial Convention Center, Room 296

Let’s Connect

Drop a line for our sales representative to get in touch with you

  • This field is for validation purposes and should be left unchanged.

Latest Article

images

Increase Your Contact Lens Capture Rate with These Tips

  • 23 Sep 2022

If your eye care practice sells contact lenses and eyeglasses, you might be asking a number of questions: What is capture rate? H...

images

Have a New EHR System? Why Training Your Staff Is Key

  • 14 Sep 2022

Is your medical practice switching from paper records to electronic health records (EHRs)? Are you switching from one EHR system to another? EHRs are vital tools that could assist your practice ...

images

How to Increase Patient Volume Without Hampering Quality of Care

  • 07 Sep 2022

For many health care providers, it seems like there aren’t enough hours in the day to help all the patients who need assistance. They could be wondering how to increase patient volume on a given...

Download Article

test
test
Book a Callback