2025 ICD-10-CM code H54.2
(Active) Effective Date: N/A Diseases of the eye and adnexa - Visual disturbances and blindness 7 Feed
Low vision, both eyes. Visual impairment categories 1 or 2 in both eyes.
Medical necessity for services related to low vision (e.g., low vision aids, rehabilitation) is based on the documented impact of vision impairment on the patient's daily activities and quality of life. The severity of vision loss, documented using appropriate criteria as reflected in the ICD-10-CM code, supports medical necessity for interventions aimed at maximizing remaining vision and promoting independence.
The clinician is responsible for assessing the visual acuity and visual field of the patient using appropriate charts and tests. The diagnosis must be supported by documented evidence in the medical record and meet the criteria for low vision according to ICD-10-CM guidelines. If an underlying condition causing the low vision exists (e.g. diabetic retinopathy, macular degeneration, glaucoma), that condition should be coded as well.
In simple words: This code indicates that a person has low vision in both eyes.Their vision is worse than 20/70 but better than 20/400.They can still see, but their vision is significantly impaired.
Low vision, both eyes.This code signifies visual impairment classified as category 1 (moderate visual impairment) or category 2 (severe visual impairment) affecting both eyes.Category 1 refers to visual acuity worse than 6/18 (or 3/10 or 0.3) but equal to or better than 6/60 (or 1/10 or 0.1), or a visual field of less than 20 degrees. Category 2 refers to visual acuity worse than 6/60 but equal to or better than 3/60 (or 1/20 or 0.05), or a visual field of less than 10 degrees.
Example 1: A patient presents with difficulty reading small print and recognizing faces across the room. Examination reveals visual acuity of 6/36 in the right eye and 6/48 in the left eye. Both eyes fall within the moderate to severe visual impairment range, making H54.2 appropriate., An elderly patient with macular degeneration is assessed to have a visual acuity of 6/70 in the right eye and 3/60 in the left eye. This indicates low vision in both eyes, and H54.2 is used. , A child with a congenital condition has restricted visual fields, measuring 15 degrees in both eyes, but their visual acuity is near normal. Since the visual field restriction falls into the moderate visual impairment category, H54.2 is assigned, despite the relatively good acuity.
Documentation must include the visual acuity measurements for each eye and/or the visual field measurements. It should also mention the assessment of "presenting" vision, not best-corrected vision, following WHO guidelines. Documentation of any underlying condition causing low vision is also required.
** Visual impairment categories are based on the worse eye.This code should be used for individuals who have both moderate visual impairment (category 1) or severe visual impairment (category 2) in both eyes.
- Payment Status: Active
- Specialties:Ophthalmology, Optometry
- Place of Service:Office, Outpatient Hospital, Clinic