Most of the new changes by the Centers for Medicare and Medicaid Services (CMS) for ICD-10 this fiscal year (October 1, 2020 – September 30, 2021) involve COVID-19 and vaping.  Changes in effect for ICD-10 codes as they relate to eyes are fairly straightforward.

Glaucoma

  1. Assign as many codes as needed to accurately describe the type, eye, and stage
  2. If glaucoma and stage evolve during admission in a facility assign the code for the highest stage documented. Not to be confused with changing stages over time and between visits.
  3. When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and there is a code for bilateral glaucoma, report only the code for the type of glaucoma, bilateral, with the seventh character for the stage.
  4. When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and the classification does not provide a code for bilateral glaucoma (i.e. subcategories H40.10, and H40.20) report only one code ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 Page 49 of 126 for the type of glaucoma with the appropriate seventh character for the stage.
  5. When a patient has bilateral glaucoma and each eye is documented as having a different type or stage, and the classification distinguishes laterality, assign the appropriate code for each eye rather than the code for bilateral glaucoma.
  6. When a patient has bilateral glaucoma and each eye is documented as having a different type, and the classification does not distinguish laterality (i.e., subcategories H40.10, and H40.20), assign one code for each type of glaucoma with the appropriate seventh character for the stage.
  7. When a patient has bilateral glaucoma and each eye is documented as having the same type, but different stage, and the classification does not distinguish laterality (i.e., subcategories H40.10 and H40.20), assign a code for the type of glaucoma for each eye with the seventh character for the specific glaucoma stage documented for each eye.
  8. Indeterminate stage glaucoma Assignment of the seventh character “4” for “indeterminate stage” should be based on the clinical documentation. The seventh character “4” is used for glaucoma whose stage cannot be clinically determined. This seventh character should not be confused with the seventh character “0”, unspecified, which should be assigned when there is no documentation regarding the stage of the glaucoma.

Blindness

  1. If “blindness” or “low vision” of both eyes is documented but the visual impairment category is not documented, assign code H54.3, Unqualified visual loss, both eyes.
  2. If “blindness” or “low vision” in one eye is documented but the visual impairment category is not documented, assign a code from H54.6-, Unqualified visual loss, one eye.
  3. If “blindness” or “visual loss” is documented without any information about whether one or both eyes are affected, assign code H54.7, Unspecified visual loss.

Find more info at the CMS site

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