What are the ICD-10 Codes to Report Low Vision and Blindness?

Hello and welcome to our podcast series. My name is Meghann Drella and I’m a Senior Solutions Manager here at Outsource Strategies International (OSI). Today, I’ll be discussing ICD-10 codes to report low vision and blindness.

Ophthalmology and optometry practices must report the diagnosis for low vision and blindness on their medical claims using H54 ICD-10 codes. Low vision refers to chronic visual impairments that cannot be corrected with glasses, contact lenses, or medical or surgical treatment. Low vision includes different degrees of sight loss, from blind spots, poor night vision and problems with glare to an almost complete loss of sight. Blindness and low vision are not the same, as limited sight remains in the latter condition.

As you know, February is low vision awareness month and it is also national age-related macular degeneration (AMD) month. AMD is the leading cause of low vision and blindness. Other causes include glaucoma, cataract and diabetes. This month is meant to spread awareness about vision rehabilitation that can help people with low vision learn how to stay independent and make the most of their sight.

01:06 Diagnosis and Treatment for Low Vision

Getting a yearly exam increases the chances of early detection and diagnosis of conditions that may lead to vision loss. Low vision can make it harder to do things like reading, shopping, or cooking. Ophthalmologists and optometrists concerned with the eye and vision, measure visual impairments by making patients read letters on a vision chart, which is called visual acuity. Two categories of low vision are – Partially sighted and Legally blind. Partially sighted refers to visual acuity between 20/70 and 20/200 with conventional prescription lenses and Legally blind refers to visual acuity no better than 20/200 with conventional correction and/or a restricted field of vision less than 20 degrees wide. Visual aids are helpful for people with low vision. Popular low vision aids include telescopic glasses, lenses that filter light, magnifying glasses, hand magnifiers, closed-circuit television and reading prisms.

To document low vision and blindness in medical claims, the categories are – mild or no visual impairment, moderate, severe, and blindness. ICD 10 Monitor provides a clear idea of those categories.

02:19 Related ICD-10 Codes

Please refer to the article attached for this chart as well as the list of ICD-10 codes associated with these procedures.H54 Blindness and low vision

• H54.0 Blindness, both eyes
  • H54.0X Blindness, both eyes, different category levels
    • H54.0X3 Blindness right eye, category 3
      • 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
    • H54.0X4 Blindness right eye, category 4
      • 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
    • H54.0X5 Blindness right 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

• H54.1 Blindness, one eye, low vision other eye
  • H54.10 …… unspecified eyes
    • H54.11 Blindness, right eye, low vision left eye
      • H54.113 Blindness right eye category 3, low vision left eye
      • H54.1131 …… category 1
      • H54.1132 …… category 2
      • H54.114 Blindness right eye category 4, low vision left eye
      • H54.1141 …… category 1
      • H54.1142 …… category 2
      • H54.115 Blindness right eye category 5, low vision left eye
      • H54.1151 …… category 1
      • H54.1152 …… category 2
    • H54.12 Blindness, left eye, low vision right eye
      • H54.121 Low vision right eye category 1, blindness left eye
      • H54.1213 …… category 3
      • H54.1214 …… category 4
      • H54.1215 …… category 5
      • H54.122 Low vision right eye category 2, blindness left eye
      • H54.1223 …… category 3
      • H54.1224 …… category 4
      • H54.1225 …… category 5

• H54.2 Low vision, both eyes
  • H54.2X Low vision, both eyes, different category levels
    • H54.2X1 Low vision, right eye, category 1
      • 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
    • H54.2X2 Low vision, right 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
• H54.4 Blindness, one eye
  • H54.40 …… unspecified eye
  • H54.41 Blindness, right eye, normal vision left eye
    • H54.413 Blindness, right eye, category 3
      • H54.413A Blindness right eye category 3, normal vision left eye
    • H54.414 Blindness, right eye, category 4
      • H54.414A Blindness right eye category 4, normal vision left eye
    • H54.415 Blindness, right eye, category 5
      • H54.415A Blindness right eye category 5, normal vision left eye
  • H54.42 Blindness, left eye, normal vision right eye
    • H54.42A Blindness, left eye, category 3-5
      • 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

• H54.5 Low vision, one eye
  • H54.50 …… unspecified eye
  • H54.51 Low vision, right eye, normal vision left eye
    • H54.511 Low vision, right eye, category 1-2
      • H54.511A Low vision right eye category 1, normal vision left eye
      • H54.512A Low vision right eye category 2, normal vision left eye
  • H54.52 Low vision, left eye, normal vision right eye
    • H54.52A Low vision, left eye, category 1-2
      • H54.52A1 Low vision left eye category 1, normal vision right eye
      • H54.52A2 Low vision left eye category 2, normal vision right eye

• H54.6 Unqualified visual loss, one eye
  • H54.60 …… 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

It is important for coding and billing staff to be very cautious in choosing the specific codes, and they must be up to date with the payer policies to avoid claim rejections.

I hope this helps, but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for joining me and stay tuned for my next podcast.