ICD-10 CODING GUIDELINES FOR
LOW VISION & BLINDNESS The new diagnosis coding changes related to blindness and low vision that have come into effect from October 1, 2017. www.outsourcestrategies.com
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Low vision is a term characterized by a level of vision that is 20/70 or worse and that cannot be fully corrected with medical treatment, surgery, or conventional glasses. Unlike blindness, most individuals with low vision have some useful sight. It is estimated that around 14 million people in the United States suffer from low vision. A regular medical eye examination by an ophthalmologist is important to diagnose the problem early. Starting from October 1, 2017 certain new diagnosis coding changes have come into effect for blindness and low vision. Coders in reliable medical coding companies need to prepare and understand how to use the new code set to accurately bill for blindness and associated conditions. In 2013, the World Health Organization (WHO) campaigned for greater clarity in the reporting of blindness and low vision. The latest update in codes will bring potential changes in documentation standards and understanding the category levels in a better manner. The category H54 – is applicable to visual impairment categories 3, 4, 5 (in both eyes) and includes codes for blindness and low vision and with that brings many prominent changes for documentation and coding. About 50 new codes were added to the blindness and low vision (H54) code set. These new code categories are meant to allow physicians to more correctly capture the vision status of their patients with low vision and enable physicians to report the category of visual impairment (as defined by the WHO).
Diagnosing Low Vision Symptoms Low vision can occur at any stage of life, but primarily it affects the elderly people. In most cases, people experience these symptoms as a result of certain eye conditions
and
diseases
such
as
diabetic
retinopathy,
glaucoma,
macular
degeneration, cataracts, retinitis pigmentosa and other injuries. Low vision is permanent loss of vision that won’t improve with eyeglasses, medicine or surgery. People with low vision fall under two main categories – partially sighted (having vision acuity between 20/70 and 20/200 with the aid of corrective lenses) or legally blind (vision is no better than 20/200 with regular correction aids).As per the ICD-10 Monitor report, the World Health Organization (WHO) reports that
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recent studies show that the use of “best corrected” vision overlooks large portions of visual impairments, including blindness, due to uncorrected refracted error. Uncorrected refractive error is now being considered as a prominent cause of visual impairment and estimations are ongoing to calculate the loss in terms of disabilityadjusted life years (DALY) resulting from this cause. Generally, refractive error condition caused by myopia, hyperopia, astigmatism and presbyopia occurs when the eye does not focus on images properly on the retina, leading to blurred vision. The new ICD-10 coding changes introduced on October 1, 2017for blindness and low vision include the following.
In the new coding convention - the term “best corrected” is being replaced with the word “presenting.”
The new codes introduce several categories and clinical documentation will include Type Stage (category) Laterality
Categories– Mild or no visual impairment Moderate visual impairment Severe visual impairment Blindness
New ICD-10 Codes for Blindness and Low Vision Ophthalmology medical coding can be quite complex due to varying documentation requirements and using a combination of comprehensive eye codes. Below are a list of new codes for blindness and low vision – 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
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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
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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 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
Due to the complexity of the combination codes, using the above mentioned new codes can be difficult for medical coders. Therefore, a new documentation guideline for using these codes is recommended –
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.
On the other hand, if the visual impairment category is not documented, ‘unspecified’ should be used.
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Implementing the complex new combination codes for blindness and low vision will be an easy task with an extended support from a reliable medical coding service provider. Coders in a professional company will keep themselves updated about the changing codes and use the unspecified codes correctly, thereby avoiding claim denials.
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