Optometry Coding & Billing Alert

Published on Tue Dec 15, 2015 PDF

ICD-10 simplifies code set to 17 codes from 45 in ICD-9.

While the enormity of making the transition to ICD-10 can seem overwhelming, the new system makes coding many conditions easier and more specific. Case in point: In ICD-10, you have to choose from only 17 codes for blindness and low vision, compared to the 45 codes you used to have in this ICD-9 category.

Prior to October 1, 2015, you turned to 369.xx (Blindness and low vision) when your patient is diagnosed with a visual impairment. Now, you should be looking to H54.-- (Blindness and low vision). The codes in the H54.-- category break down as follows:

• H54.0 – Blindness, both eyes
• H54.10 – Blindness, one eye, low vision other eye, unspecified eyes
• H54.11 – Blindness, right eye, low vision left eye
• H54.12 – Blindness, left eye, low vision right eye
• H54.3 – Unqualified visual loss, both eyes
• H54.40 – Blindness, one eye, unspecified eye
• H54.41 – Blindness, right eye, normal vision left eye
• H54.42 – Blindness, left eye, normal vision right eye
• H54.50 – Low vision, one eye, unspecified eye
• H54.51 – Low vision, right eye, normal vision left eye
• H54.52 – Low vision, left eye, 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
• H54.8 – Legal blindness, as defined in USA.

Compare the Coding Systems

To get a better idea of how ICD-10 approaches coding for visual impairment, let’s compare the codes for blindness in ICD-9 with those in ICD-10.

For a patient with blindness in both eyes, you used to select either 369.4 (Legal blindness, as defined in the USA [includes Blindness NOS according to the USA definition]) or 369.01 (Better eye: total vision impairment; lesser eye: total vision impairment) in ICD-9, depending on the documentation.

In ICD-10, your code would be H54.8 (Legal blindness, as defined in USA).

Another difference: The 369.0x (Profound vision impairment both eyes) subcategory included nine codes broken out by the level of impairment in each eye. While in ICD-10, the H54.1- (Blindness, one eye, low vision other eye) subcategory breaks out blindness and low vision into just three choices depending on which eye has the blindness.

Don’t Miss New Sequencing Rules

When reporting that your patient has a visual impairment, you should also list a code that describes the reason for the vision problem. In ICD-9, you had no instruction that says one condition has to be coded before the other, but in ICD-10, you’re asked to sequence any associated underlying cause of blindness before the H54.-- code.

Note: Visual acuity with best possible correction means with glasses with best possible correction.