Coding Low Vision


This just in from AdvanceMed:

The case-mix diagnosis of low vision did not meet the criteria for use. According to
coding guidelines, an underlying diagnosis should be identified. The 369 category excludes correctable refractive errors such as nearsightedness, astigmatism and farsightedness. No documentation was submitted to support that the beneficiary had an underlying disease process that would allow the diagnosis of Low Vision (I CD code 369.xx) to be used in the case mix diagnosis. The documentation did not address how this diagnosis would affect the patient’s responsiveness to treatment and rehabilitative progress. The documentation also failed to display the impact the low vision had on the patient or his plan of care. There were no interventions listed for this diagnosis that required additional resources. M0390 (OASIS Bl) alone is not justification for applying the low vision diagnoses.

This is actual language from a denial in a ZPIC audit.  It is used repeatedly in the ‘educational’ documentation sent to the agency along with their results highlighting the reasons for denials.

Questions?