ICD-10 Coding for Low Vision(H54.0, H54.2)
Complete ICD-10-CM coding and documentation guide for Low Vision. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Low Vision
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 | When both eyes are completely blind. |
|
| H54.2 | Low vision, both eyes | When both eyes have reduced vision but are not completely blind. |
|
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 low vision
Essential facts and insights about Low Vision
Primary ICD-10-CM Codes for low vision
Decision Criteria
clinical Criteria
- Visual acuity of 20/400 or worse in both eyes
Applicable To
- Complete loss of vision in both eyes
Excludes
- Blindness in one eye with low vision in the other eye
Clinical Validation Requirements
- Documented visual acuity of 20/400 or worse in both eyes
Code-Specific Risks
- Misclassification if visual acuity is not properly documented.
Coding Notes
- Ensure visual acuity is documented for both eyes.
H54.2 - Low vision, both eyes
When both eyes have reduced vision but are not completely blind.
Applicable To
- Partial sight in both eyes
Excludes
- Blindness in one eye with low vision in the other eye
Clinical Validation Requirements
- Documented visual acuity between 20/70 and 20/400 in both eyes
Coding Notes
Ensure documentation of visual acuity for both eyes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Low 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: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with coding guidelines., Financial: Potential for denied claims.
Mitigation Strategy
Always include the primary diagnosis causing low vision., Use comprehensive eye examination notes.
Impact
Reimbursement: May lead to reduced reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of health records.
Mitigation Strategy
Always specify laterality and category when documentation is available.
Impact
High risk of audits due to lack of specificity in coding.
Mitigation Strategy
Ensure detailed documentation of visual acuity and functional impact.
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 Low Vision, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Low Vision
Use these documentation templates to ensure complete and accurate documentation for Low Vision. These templates include all required elements for proper coding and billing.
Low vision evaluation
Specialty: OphthalmologyRequired Elements
- Visual acuity measurements
- Contrast sensitivity
- Functional impact
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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