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H54 Error in ICD-10-CM Code Set

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  • In ICD-10
  • January 19, 2018
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H54 Error in ICD-10-CM Code Set

Two years on, ICD-10-CM still has some rough edges.
CMS does not include 7th  character options for several codes under category H54. Out of a total of 50,274 7  character codes in the ICD-10-CM 2018 code set, there are 35 codes for which CMS does not include a 7th character options note in the Tabular List. CMS has not yet released an errata on their website showing these errors.

H54 Category

For example, 7 character code H54.511A falls under 6th character code H54.511 but 7 character code H54.512A also fallunder 6th character code H54.511. It appears CMS placed it under the incorrect 6th character code.
But the instructions are there.

The appropriate 7th character is to be added to each code from H54.0-H54.2:

1 – low vision, left eye, category 1

2 – low vision, left eye, category 2

3 – blindness, left eye, category 3

4 – blindness, left eye, category 4

5 – blindness, left eye, category 5

The appropriate 7th character is to be added to each code from H54.4: a – normal vision, left eye

– category 1, normal vision, right eye 2

– category 2, normal vision, right eye 3

– category 3, normal vision right eye 4

– category 4, normal vision right eye 5

– category 5, normal vision right eye

It’s not unusual for minor errors to appear in a code set, and save for ophthalmologists, this particular situation won’t widely impact reimbursement.

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Brad Ericson
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Brad Ericson, MPC, CPC, COSC, is a seasoned healthcare writer and editor. He directed publishing at AAPC for nearly 12 years and worked at Ingenix for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

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