Looking at new ICD-10-CM Codes for Blindness

A new set of codes was released for use beginning on Oct. 1, 2017. The category, H54, includes codes for blindness and low vision and with that brings many changes for documentation and coding.

In 2013 the World Health Organization (WHO) campaigned for greater clarity in the reporting of blindness and low vision and with this latest update we will be following those parameters. What that means for us is a potential change in documentation standards and understanding the category levels.

The definition of visual impairment and blindness contained the term “best Corrected Vision in the better eye. According to WHO, recent studies have shown that the use of “best corrected” vision overlooks large portions of visual impairments, including blindness, due to uncorrected refracted error. This is common occurrence in many parts of the world.

Uncorrected refractive error is now considered to be a major cause of visual impairment and estimations are under way to calculate the loss in terms of disability-adjusted life years (DALY) resulting from this cause.

In the new coding convention, the words “best corrected” is being replaced with the word “presenting.”

The new codes introduce categories. Documentation will need to include:

• Type
• Stage (category)
• Laterality

Categories are divided between mild or no visual impairment, moderate, severe and blindness.

• Or counts fingers at 1 metre.

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

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

These codes could be confusing when first starting to use them due to the complexity of the combination codes. There is also a new guideline applicable as well.

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 guideline is the new chapter specific guideline for the codes listed above. If the visual impairment category is not documented we are instructed to use the unspecified.

Always be cautious when using unspecified codes and be sure to check payer policies to avoid rejections.

PROGRAM NOTE: Listen to Rhonda Buckholtz discuss the new codes for blindness and low vision today on Talk Ten Tuesdays, 10-10:30 a.m. ET. Register to listen.