ICD-10 2017 Update: 2 Changes Affect Ophthalmology

About 50 new ICD-10 codes affecting ophthalmology took effect Oct. 1, 2017. Two of the most significant changes allow for more precise coding of myopic degeneration and vision rehabilitation.

Most Medicare administrative contractors have updated their policies to reflect these new codes; however, commercial payers may not be on the same timeframe as Medicare, so be sure to watch for payer updates and alerts to ensure your claims are processed correctly.

1. Myopic degeneration  

You now have 15 codes for myopic degeneration instead of three.

Before: The code family was simply H44.2- Degenerative myopia, with the fifth character indicating laterality.

As of Oct. 1, 2017: Laterality moves to a new sixth character; use the fifth character to show additional conditions the patient may have. To avoid confusion, the new fifth-character options use letters, rather than numbers

A—Choroidal neovascularization
B—Macular hole
C—Retinal detachment
D—Foveoschisis
E—Other maculopathy

You now use the new, numeric, sixth character to indicate laterality:

1—Right
2—Left
3—Bilateral

How to code all possible combinations:

2. Vision rehabilitation/Low vision

Before: The code family was only five characters long, with simply H54. as the route code. 

As of Oct. 1, 2017: The code family now has seven characters to indicate impairment with much more precision. For all codes in this family, you must now complete all seven coding positions (e.g. H54.- - - - ).

• You now report the status of each eye individually.
• The level of visual impairment is now broken into categories, per eye, that determine whether the patient has low vision (1 and 2) or is blind (3, 4 and 5). Find full definitions in the table below.

This expansion gives you different coding possibilities when one eye falls under the same or different category as the other eye.

The route code remains H54. Blindness and low vision. The changes affect the next three parts of the code:

1. The fourth/fifth characters, which have six combinations to show whether both eyes are considered blind, low vision, or if each eye is in a different category;
2. The new sixth position, which designates the right eye category; and
3. The new seventh position, which indicate the left eye.

Options for coding the overall combination of vision (characters four/five):

.0X—Bilateral blindness:
.11—Blindness, right eye; low vision, left eye
.12—Low vision, right eye; blindness, left eye
.2X—Bilateral low vision:
.41—Blindness, right eye; normal vision, left eye
.42—Normal vision, right eye; blindness left eye
.51 - Low vision right eye; normal vision left eye
.52 - Normal vision right eye, low vision left eye

The final two characters indicate category per eye. For both the sixth and seventh characters (character 6 = right eye, character 7 = left eye), choose from the same set of alphanumeric options. See the classification chart below for precise definitions of vision categories.

A—Normal vision
1—Moderate visual impairment, VA worse than 20/70 and better than or equal to 20/200
2—Severe visual impairment, VA worse than 20/200 and better than or equal to 20/400
3—Blindness, VA worse than 20/400 and better than or equal to 5/300 (20/1200)
4—Blindness, VA worse than 5/300 and better than or equal to light perception
5—Blindness with no light perception

Some examples:

• Right eye: 20/500, Left eye: light perception: H54.0X34
• Bilateral blindness = H54.0X; right eye: category 3; left eye: category 4
• Right eye: 20/1200, Left eye: 20/80: H54.1131
• Blindness, right eye; low vision, left eye = H54.11; right eye: category 3; left eye: category 1
• Right eye: 20/2000, left eye: 20/400: H54.1142
• Blindness, right eye; low vision, left eye = H54.11; right eye: category 4; left eye: category 2
• Right eye: 20/250, Left eye: 20/600: H54.1223
• Low vision, right eye; blindness, left eye = H54.12; right eye: category 2; left eye: category 3
• Right eye: 20/100, left eye: 20/1000: H54.1213
• Low vision, right eye; blindness, left eye: = H54.12; right eye: category 1; left eye: category 3
• Right eye: 20/200, Left eye: 20/400: H54.2X12
• Bilateral low vision = H54.2X; right eye: category 1; left eye: category 2
• Right eye: 20/600, Left eye: 20/30: H54.413A
• Blindness, right eye; normal vision, left eye = H54.41; right eye: category 3, left eye: normal vision (category A)
• Right eye: 20/15, Left eye: no light perception: H54.42A5
• Normal vision, right eye; blindness left eye = H54.42; right eye: normal vision (category A), left eye: category 5

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Additional resources

The Academy’s new decision trees offer additional help in coding for myopic degeneration and vision rehabilitation. For more information on the other 2017 coding edits that took effect Oct. 1, check out the Academy’s ICD-10-CM for Ophthalmology.

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About the authors: Jenny Edgar, CPC, CPCO, OCS, is the Academy’s coding specialist. She is also a contributing author to the Ophthalmic Coding Coach and Ophthalmic Coding series. Sue Vicchrilli, COT, OCS, is the Academy’s director of coding and reimbursement and the author of EyeNet’s “Savvy Coder” column and AAOE’s Practice Management Express, Ophthalmic Coding Coach and Ophthalmic Coding series.