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Myopia, Hypermetropia and Astigmatism F076

Last amended 
17 March 2016
Current RMA Instruments:
Reasonable Hypothesis SOP9 of 2016
Balance of Probabilities SOP 10 of 2016
Changes from previous instruments:

SOP Bulletin 188

ICD Coding:
  • ICD-9-CM Codes: 360.21,367.0,367.1,367.2
  • ICD-10-AM Codes:H44.2, H52.0, H52.1, H52.2
Brief description

This SOP is effectively three SOPs in one, for the three different types of refractive error.  A refractive error occurs when the eye cannot clearly focus images, resulting in blurred vision.  The three main types are:

  • myopia (nearsightedness): difficulty in seeing distant objects clearly;
  • hypermetropia (farsightedness): difficulty in seeing close objects clearly;
  • astigmatism: distorted vision resulting from an irregularly curved cornea
Confirming the diagnosis

Diagnosis is based on a report from an ophthalmologist or optometrist.

To apply the SOP you will need to identify the type/s of refractive error.  If more than one type of refractive error is present in an eye, ie. hypermetropic astigmatism or myopic astigmatism, you may need to separately encode and determine each type, because of the potentially different causal factors that apply (note that myopia and hypermetropia cannot coexist in the same eye).

Additional diagnoses covered by SOP
  • hyperopia
  • hypermetropic astigmatism
  • myopic astigmatism
Related conditions that may be covered by SOP (further information required)
  • short or near sightedness
  • farsightedness
Conditions excluded from SOP
  • presbyopia - another SOP applies
Further comments on diagnosis

All people over the age of 50 and most people between ages 40 and 50 will have diminished near vision due to presbyopia.  Presbyopia has its own RMA SOPs (ICD code 367.4).

Clincial onset

Clinical onset may be different for each eye.  It will be when the refractive error was first documented by an optometrist or ophthalmologist, or when blurred vision, subsequently confirmed to be due to a refractive error, was first noted.

Clincial worsening

Refractive errors tend to be fairly stable in adults although changes can occur as part of the natural history.  Worsening would be reflected by a deterioration in visual acuity not due to some other condition (including presbyopia).