Which comes first when coding for a patient with glaucoma and blindness?
A “code first” note to code “any associated underlying cause of the blindness” at the H54.- (Blindness and low vision) category level tips you off that when glaucoma caused your patient’s blindness, you’ll sequence the glaucoma first followed by the blindness.
Glaucoma codes are separated by type, stage and affected eye. Patients can have different types and stages of glaucoma in different eyes with varying levels of visual impairment. This may require you to report different codes for each eye, depending on the circumstances.
For example: You’ll need a total of three codes to completely capture a patient with severe stage primary open-angle glaucoma in the left eye and moderate stage primary open-angle glaucoma in the right eye, with resultant category 2 low vision in the right eye and category 4 blindness in the left:
- H40.1123 (Primary open-angle glaucoma, left eye, severe stage),
- H40.1112 (Primary open-angle glaucoma, right eye, moderate stage), and
- H54.1224 (Low vision right eye category 2, blindness left eye category 4).
Use documentation to guide coding
Ask yourself the following questions when perusing documentation to assign the most specific code for the patient’s blindness and low vision:
- Is the visual impairment limited to one eye or both?
- If the visual impairment is limited to one eye, which eye is affected?
What is the level of impairment (such as category 1 or category 5) for each eye?