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