Visual Refractive Error F076

Current RMA Instruments

Changes from previous instruments

ICD Coding

• ICD-10-AM Codes: H44.2, H52.0, H52.1, H52.2, H52.3

Brief description

Visual refractive errors occur when the eye is unable to clearly focus images, typically due to an abnormal shape of the cornea or lens, or an abnormal length of the eyeball. These irregularities prevent light from focusing properly on the retina, resulting in blurred vision and reduced visual acuity. The SoP covers a group of eye diseases which includes:

• Myopia (nearsightedness): difficulty seeing distant objects clearly
• Hyperopia (farsightedness or hypermetropia): difficulty seeing nearby objects clearly
• Astigmatism: distorted or blurred vision due to an irregularly curved cornea
• Anisometropia: a condition where there is a difference in refractive error of ≥1 diopter between the eyes, resulting in one eye having poorer vision than the other. It is therefore due to varying degrees of myopia, hyperopia or astigmatism in each eye. 

If more than one type of refractive error is present in an eye, each type may need to be separately identified and assessed, as they may have different underlying causes.

Note: Myopia and hypermetropia cannot co-exist in the same eye.

Confirming the diagnosis

The specific diagnosis is established by an ophthalmologist or optometrist based on a clinical eye assessment. 

Additional diagnoses covered by SOP

• Nearsightedness
• Farsightedness  
• Hypermetropia
• Myopia includes:
  • benign myopia, simple myopia, school myopia, physiological myopia, pathological myopia, non-pathological myopia, curvature myopia, index myopia, refractive myopia, axial myopia, progressive myopia, stationary myopia, degenerative myopia, low myopia, high myopia
• Hyperopia includes:
  • curvature hyperopia, index hyperopia, axial hyperopia, low hyperopia, high hyperopia
• Astigmatism includes:
  • myopic astigmatism, hyperopic astigmatism, mixed astigmatism, simple astigmatism, compound astigmatism, regular astigmatism, irregular astigmatism, with-the-rule astigmatism, against-the-rule astigmatism, oblique astigmatism, bioblique astigmatism, corneal astigmatism, lenticular astigmatism, retinal astigmatism  

Conditions excluded from SOP

• Presbyopia * - All people over 50 and most people between 40 and 50 will have diminished near vision due to presbyopia as a result of age-related lens changes. It can be confused with hyperopia (hypermetropia), as both impair near vision. However, presbyopia results from reduced lens flexibility with age, while hyperopia is due to structural abnormalities of the eye, such as a shorter eyeball or irregular shape of the cornea or lens. 
• Amblyopia # - potential consequence of untreated refractive conditions, not a refractive error itself 

*another SOP applies

#non-SOP condition 

Clinical onset

Clinical onset may differ between the eyes. It is defined as the point at which the refractive error was first documented by an optometrist or ophthalmologist, or when blurred or decreased vision- subsequently confirmed to be due to a refractive error- was first noted.

Clinical worsening

Refractive errors are generally stable in adults; however, changes can occur as part of the natural progression of conditions such as degenerative myopia, or as a result of ocular disease or trauma. It is important to determine whether any clinical worsening is consistent with the expected natural history of the condition. This assessment typically requires the opinion of an ophthalmologist. In most cases, refractive errors can be effectively corrected with glasses or contact lenses.