Starting October 1, 2017, a new set of ICD-10 codes have come into effect for blindness and low vision. Coders in medical coding companies will have to fully understand how to use the new code set to correctly report claims for blindness for ophthalmology practices.
The new 2018 ICD-10 code category is H54.0 Blindness and low vision
H54 is applicable to visual impairment categories 3, 4, 5 in both eyes. It includes codes for blindness and low vision and introduces many changes for documentation and coding.
Diagnosing blindness involves testing each eye individually and measuring the visual acuity and the visual field, or peripheral vision. Unilateral blindness refers to blindness in one eye and bilateral blindness to poor/loss of vision in both eyes. An ophthalmologist diagnoses blindness by a thorough exam as well as an evaluation of historical information regarding the blindness. The causes of temporary blindness are different from those of permanent blindness. Also, the potential causes of blindness will differ based on whether the condition is a sudden onset, or progressive or chronic.
Low vision is a condition caused by eye disease in which visual acuity is 20/70 or poorer in the better-seeing eye and cannot be corrected. The term “best Corrected Vision in the better eye” defines visual impairment and blindness. However, according to an ICD10 Monitor report, the World Health Organization (WHO) noted that studies show that the term “best corrected” vision fails to consider large portions of visual impairments, including blindness, due to uncorrected refracted error.
Uncorrected refractive error is a common occurrence in many countries and is now regarded as a major reason for visual impairment. Refractive errors occur when the eye is unable to properly focus images on the retina, resulting in blurred vision. The condition is caused by myopia, hyperopia, astigmatism and presbyopia. Studies are now trying to find a way to calculate the loss in terms of disability-adjusted life years (DALY) resulting from uncorrected refractive error.
The latest ICD-10 code update is based on the WHO’s recommendation for greater clarity in the reporting of blindness and low vision. Medical coding service providers need to be aware of the potential changes in documentation standards and understand the category levels.
The newly added codes further classify blindness and low vision. Here are the changes which went into effect on October 1, 2017:
- The term “best corrected” has been replaced with the word “presenting.”
- The new codes involve new categories and clinical documentation will have to specify:
- Type
- Stage (category)
- Laterality
- Categories are divided between:
- Mild or no visual impairment
- Moderate visual impairment
- Severe visual impairment
- Blindness
The ICD10 Monitor report lists the new ICD-10 codes for blindness and low vision as follows:
- 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
- H54.0X43 Blindness right eye category 4, blindness left eye category 3
- H54.0X44 Blindness right eye category 4, blindness left eye category 4
- H54.0X45 Blindness right eye category 4, blindness left eye category 5
- H54.0X53 Blindness right eye category 5, blindness left eye category 3
- H54.0X54 Blindness right eye category 5, blindness left eye category 4
- H54.0X55 Blindness right eye category 5, blindness left eye category 5
- H54.10 Blindness, one eye, low vision other eye, unspecified eyes
- H54.1131 Blindness right eye category 3, low vision left eye category 1
- H54.1132 Blindness right eye category 3, low vision left eye category 2
- 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
- H54.1151 Blindness right eye category 5, low vision left eye category 1
- H54.1152 Blindness right eye category 5, low vision left eye category 2
- H54.1213 Low vision right eye category 1, blindness left eye category 3
- H54.1214 Low vision right eye category 1, blindness left eye category 4
- H54.1215 Low vision right eye category 1, blindness left eye category 5
- H54.1223 Low vision right eye category 2, blindness left eye category 3
- H54.1224 Low vision right eye category 2, blindness left eye category 4
- H54.1225 Low vision right eye category 2, blindness left eye category 5
- H54.2X11 Low vision right eye category 1, low vision left eye category 1
- H54.2X12 Low vision right eye category 1, low vision left eye category 2
- H54.2X21 Low vision right eye category 2, low vision left eye category 1
- H54.2X22 Low vision right eye category 2, low vision left eye category 2
- H54.3 Unqualified visual loss, both eyes
- H54.40 Blindness, one eye, unspecified eye
- H54.413A Blindness right eye category 3, normal vision left eye
- H54.414A Blindness right eye category 4, normal vision left eye
- H54.415A Blindness right eye category 5, normal vision left eye
- H54.42A3 Blindness left eye category 3, normal vision right eye
- H54.42A4 Blindness left eye category 4, normal vision right eye
- H54.42A5 Blindness left eye category 5, normal vision right eye
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- H54.50 Low vision, one eye, unspecified eye
- H54.511A Low vision right eye category 1, normal vision left eye
- H54.512A Low vision right eye category 2, normal vision left eye
- H54.52A1 Low vision left eye category 1, normal vision right eye
- H54.52A2 Low vision left eye category 2, normal vision right eye
- H54.60 Unqualified visual loss, one eye, unspecified
- H54.61 Unqualified visual loss, right eye, normal vision left eye
- H54.62 Unqualified visual loss, left eye, normal vision right eye
- H54.7 Unspecified visual loss
The new documentation guideline for these codes is as follows: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.
In the documentation does not include the visual impairment category, ‘unspecified’ should be used.
Experienced medical coding service providers keep track of changing codes and documentation updates. Implementing the complex new combination codes for blindness and low vision will be much easier with such expert support. Reliable coders know how to use the unspecified codes correctly and are also knowledgeable about payer guidelines. This is crucial to avoid claim denials and ensure optimal reimbursement.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.