ICD-10 Coding for Decreased Vision(H54.0, H54.1)
Complete ICD-10-CM coding and documentation guide for Decreased Vision. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Decreased Vision
H54.0-H54.7Primary Range
Blindness and low vision
This range covers all codes related to blindness and low vision, including specific categories for each eye.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H54.0 | Blindness, both eyes | Use when both eyes have complete vision loss. |
|
| H54.1 | Blindness, one eye, low vision other eye | Use when one eye is blind and the other has low vision. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for decreased vision
Essential facts and insights about Decreased Vision
Primary ICD-10-CM Codes for decreased vision
Decision Criteria
clinical Criteria
- Visual acuity less than 20/400 in both eyes
Applicable To
- Complete loss of vision in both eyes
Excludes
- Functional vision loss (H53.8)
Clinical Validation Requirements
- Documented visual acuity less than 20/400 in both eyes
Code-Specific Risks
- Ensure documentation supports complete blindness to avoid audit issues.
Coding Notes
- Ensure to document the etiology of blindness if known.
H54.1 - Blindness, one eye, low vision other eye
Use when one eye is blind and the other has low vision.
Applicable To
- Blindness in one eye with low vision in the other
Excludes
- Unspecified vision loss (H54.7)
Clinical Validation Requirements
- Documented blindness in one eye and low vision in the other
Coding Notes
Document the specific category of low vision for the affected eye.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Decreased Vision to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H54.0.
Impact
Clinical: May lead to incorrect treatment plans., Regulatory: Non-compliance with coding guidelines., Financial: Potential claim denials or reduced reimbursement.
Mitigation Strategy
Use templates that prompt for laterality, Train staff on importance of detailed documentation
Impact
Reimbursement: May lead to reduced reimbursement due to lack of specificity., Compliance: Increases risk of audit due to non-specific coding., Data Quality: Decreases data quality and accuracy in patient records.
Mitigation Strategy
Document specific visual acuity and use the appropriate specific code.
Impact
High risk of audit when using unspecified codes like H54.7 without justification.
Mitigation Strategy
Always document specific visual acuity and use the most specific code available.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Decreased Vision, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Decreased Vision
Use these documentation templates to ensure complete and accurate documentation for Decreased Vision. These templates include all required elements for proper coding and billing.
Bilateral low vision from diabetic retinopathy
Specialty: OphthalmologyRequired Elements
- Visual acuity measurements
- Etiology of vision loss
- Functional impact on daily activities
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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