Crystal's MCW Coder HubICD-10 H47.291: Other Optic Atrophy, Right Eye
Quick Reference Table
| Element | Value |
|---|---|
| ICD-10 Code | H47.291 |
| Diagnosis | Other optic atrophy, right eye |
| Parent Category | H47.29 - Other optic atrophy (non-billable parent)[1][2] |
| Chapter | VII - Diseases of the eye and adnexa (H00-H59)[3] |
| Subcategory Group | H46-H47 - Disorders of optic nerve and visual pathways[3][4] |
| Laterality | Right eye (OD) |
| Type | Non-primary, non-glaucomatous optic atrophy (other specified cause)[1][2] |
| Billable | ✓ Yes (specific, reportable) |
| Requires 7th Digit | ✗ No |
| Typical Etiologies | Ischemic optic neuropathy, compressive lesions, hereditary optic neuropathies, toxic/nutritional optic neuropathy, post-inflammatory sequelae[4][5][6] |
| Common Signs | Optic disc pallor (often temporal), RNFL thinning, decreased visual acuity, visual field defects, RAPD[4][6][7] |
| HCC Status | No (non-HCC) |
Short Definition
H47.291 is a billable ICD-10-CM code for “Other optic atrophy, right eye,” used when there is chronic structural damage and thinning of the right optic nerve from a cause that is not primary (idiopathic) and not specifically glaucomatous, and the etiology is documented as some “other” optic neuropathy (ischemic, compressive, hereditary, toxic, post-inflammatory, etc.).[1][2][4]
Full Description
What “Other Optic Atrophy” Means
Optic atrophy describes permanent degeneration of optic nerve fibers, resulting in pallor of the optic disc on fundus exam and corresponding visual dysfunction.[4][6][7]
- H47.29 = “Other optic atrophy” - non-billable parent that includes:
- Temporal pallor of optic disc.[2][8]
- H47.291 = Right-eye-specific child code:
- “Other optic atrophy, right eye” (OD) - used when the right optic nerve shows atrophy attributable to a defined cause that is not:
- Primary optic atrophy (H47.21x).
- Glaucomatous optic atrophy (H47.23x).[2][8]
- “Other optic atrophy, right eye” (OD) - used when the right optic nerve shows atrophy attributable to a defined cause that is not:
Typical etiologies captured under “other optic atrophy” include:[4][5][6][8]
- Post-ischemic optic neuropathy (non-arteritic or arteritic ION sequelae).
- Compressive optic neuropathy (pituitary adenoma, meningioma, orbital mass).
- Toxic optic neuropathy (ethambutol, linezolid, methanol, etc.).
- Nutritional optic neuropathy (B12 deficiency, folate deficiency).
- Hereditary optic neuropathy not specifically coded elsewhere (e.g., some familial cases beyond primary categories).
- Sequelae of optic neuritis or other inflammatory processes.
Pathophysiology Overview
- The optic nerve is composed of retinal ganglion cell axons that convey visual information from the retina to the brain.[4][6]
- Atrophy occurs when axons are irreversibly damaged, leading to:
- Loss of axons.
- Gliosis (scar) within the optic nerve.
- Thinning of the retinal nerve fiber layer (RNFL) and ganglion cell complex on OCT.[4][6][7]
- Clinically, this manifests as:
- Decreased visual acuity.
- Visual field defects (central, cecocentral, altitudinal, arcuate, or diffuse).
- Color vision deficits.
- Relative afferent pupillary defect (RAPD) if unilateral/asymmetric.[4][6][7]
In H47.291, these changes are localized to the right eye, with the cause documented but not fitting neatly into “primary” or “glaucomatous” categories.
Clinical Presentation
Symptoms:[4][6][7]
- Painless, chronic decrease in vision in the right eye (weeks-months).
- Difficulty with reading or recognizing faces using the affected eye.
- Defective color vision (especially red desaturation).
- Visual field loss (central, cecocentral, arcuate, altitudinal, or diffuse).
Exam Findings:
- Fundus: Optic disc pallor in the right eye (often temporal pallor, but can be diffuse).[2][7][8]
- Pupils: RAPD in the right eye if unilateral/asymmetric.
- OCT: Thinning of RNFL and ganglion cell complex OD.[7]
- VFs: Corresponding defects (e.g., centrocecal scotoma in toxic/nutritional neuropathy, altitudinal defect in ION).[4][6][9]
Coding Specifics
Code Structure Breakdown
| Characters | Value | Meaning |
|---|---|---|
| 1st-3rd | H47 | Other disorders of optic nerve and visual pathways[3][4] |
| 4th-5th | .29 | Other optic atrophy (non-billable family, includes temporal disc pallor)[1][2][10] |
| 6th | 1 | Right eye |
Thus H47.291 = Other optic atrophy, right eye - a billable, laterality-specific code.[1][2]
When to Use H47.291
Appropriate for:[1][2][8]
- Documented optic atrophy OD due to:
- Ischemic optic neuropathy sequela.
- Compressive optic neuropathy.
- Toxic/nutritional optic neuropathy.
- Inherited optic neuropathy (where no more specific hereditary code is used).
- Post-inflammatory or post-infectious optic nerve damage.
- Fundus documentation of disc pallor OD, with prior history of an optic neuropathy that is not purely glaucomatous.
- When provider states: “Optic atrophy OD due to (cause X)” and the cause is not in the primary/glaucomatous categories.
Do NOT use H47.291 when:[2][8][10]
- The atrophy is explicitly primary (idiopathic) → use H47.211 (primary optic atrophy, right eye).
- The atrophy is explicitly glaucomatous → use H47.231 (glaucomatous optic atrophy, right eye) plus glaucoma code(s).
- The involvement is left eye only → H47.292.
- The involvement is bilateral and symmetrical → H47.293 (other optic atrophy, bilateral).
- The eye is unspecified → H47.299 (other optic atrophy, unspecified eye - avoid where possible).
- The condition is active optic neuritis or acute optic neuropathy without established atrophy - use appropriate neuritis/neuropathy code (e.g., H46.x or other).
Related ICD-10 Codes (Same Family)
| Code | Description | Use When |
|---|---|---|
| H47.29 | Other optic atrophy (non-billable parent) | General category; must use a child code[2][10] |
| H47.291 | Other optic atrophy, right eye | This code - OD only[1][2] |
| H47.292 | Other optic atrophy, left eye | OS only[8][10] |
| H47.293 | Other optic atrophy, bilateral | Both eyes involved[2][8] |
| H47.299 | Other optic atrophy, unspecified eye | Eye not specified (last resort)[2] |
| H47.211 | Primary optic atrophy, right eye | Primary (idiopathic/hereditary) optic atrophy OD[8][10] |
| H47.231 | Glaucomatous optic atrophy, right eye | Optic atrophy due to glaucoma OD (with H40.x glaucoma code)[8][10] |
| H47.399 | Other disorders of optic disc, unspecified eye | If findings are disc anomalies without explicit atrophy[8] |
HCC (Hierarchical Condition Category) Status
- H47.291 is NOT HCC-weighted.
- CMS-HCC models focus on systemic, chronic conditions (e.g., diabetes, CHF, CKD, certain neurologic and ophthalmic conditions like blindness), not isolated unilateral optic atrophy codes.
- H47.291 does not map to any CMS-HCC and does not directly influence RAF scores.[3][5][11]
- However, severe optic atrophy with legal blindness may be captured via separate vision loss codes (e.g., H54.x), some of which can affect functional status and risk stratification.[4][11]
Documentation Requirements
Key Elements Providers Should Document
For accurate coding with H47.291, look for:[4][6][7][9]
-
Anatomic Site & Laterality
- “Optic atrophy OD” or “pale optic disc right eye.”
-
Etiology (If Known)
- “Optic atrophy OD secondary to non-arteritic anterior ischemic optic neuropathy (NAION).”
- “Optic atrophy OD due to compressive optic neuropathy from pituitary adenoma.”
- Toxic, nutritional, hereditary, etc.
-
Chronic vs Acute
- H47.291 implies chronic, atrophic stage, not acute neuritis.
- Document prior episode and current stable atrophy (“sequela of prior optic neuropathy”).
-
Functional Impact
- Visual acuity OD.
- Visual field defects.
- Symptoms affecting daily living (e.g., reading, driving, depth perception).
-
Imaging/Testing
- OCT RNFL thinning OD.
- Visual field printout showing defect.
- MRI/CT if compressive lesion.
-
Differential Diagnosis
- Distinguish from glaucoma (cup-disc ratio, IOP, H40.x staging) and primary optic atrophy.
Auditor Red Flags
- Label “optic atrophy OD” but simultaneously code H47.231 and H47.291 incorrectly - each has specific use (glaucomatous vs other).[2][8][10]
- No documentation of optic nerve pallor or prior neuropathy to substantiate an atrophy code.
- Using H47.291 when documentation says “primary optic atrophy” (should be H47.211) or purely glaucomatous damage.[2][8]
Associated CPT Codes
E/M and Eye Examination
| CPT | Description | Typical Use With H47.291 |
|---|---|---|
| 99202-99205 | New office/clinic visit | Initial neuro-ophthalmic evaluation |
| 99212-99215 | Established office visit | Ongoing follow-up for optic atrophy |
| 92002-92004 | Ophthalmological services, new | Eye-based exam with refraction as needed |
| 92012-92014 | Ophthalmological services, established | Follow-up optic nerve monitoring |
Diagnostic Testing
Common tests to evaluate/monitor optic atrophy OD:[7][9][12]
| CPT | Description |
|---|---|
| 92133 | Scanning computerized ophthalmic diagnostic imaging (posterior segment) - optic nerve/OCT RNFL |
| 92081-92083 | Visual field examination (screening to threshold) |
| 92202 / 92201 | Extended ophthalmoscopy with drawing including optic nerve |
| 92227-92229 | Remote or automated retinal imaging (less common for optic atrophy, but may appear in some workflows) |
| 70540-70543 | MRI orbit/brain with/without contrast (for compressive vs demyelinating etiologies) |
| 70480-70482 | CT orbit/brain (if calcified lesions or bone pathology suspected) |
Procedure/Intervention Context
While optic atrophy is not reversible, H47.291 appears in workups and management around:
- Tumor resection/radiation for compressive cause.
- Vascular risk factor management (stroke/ION workup).
- Toxic/nutritional treatment (drug cessation, vitamin therapy).
Note
Those interventions use a wide array of systemic CPT codes (neuroimaging, neuro consults), not eye-specific surgery for the atrophy itself.
Sample ICD-10 Combinations
Possible combinations depending on etiology:[4][6][9]
-
Ischemic Optic Neuropathy Sequela
- H47.291 - Other optic atrophy, right eye
- I10 / I11.x - Hypertension
- E11.9 / E11.4x - Diabetes (if present)
-
Compressive Optic Neuropathy (Pituitary Adenoma)
- H47.291 - Other optic atrophy, right eye
- D35.2 - Benign neoplasm of pituitary gland
-
Toxic/Nutritional Optic Neuropathy
- H47.291 - Other optic atrophy, right eye
- E53.8 - Deficiency of other B-group vitamins (B12) or E64.0-E64.9 for sequelae of malnutrition
Note
Always code underlying systemic conditions in addition to the optic atrophy for a complete clinical picture.
Sample Documentation (Work-Ready)
Scenario - Ischemic Optic Neuropathy Sequela (Right Eye)
HPI: 68-year-old male with history of NAION OD 1 year ago returns for follow-up. Vision OD has been stable but reduced; no new visual symptoms. Denies pain or transient visual obscurations. PMH includes hypertension and type 2 diabetes.
Exam:
- VA: 20/200 OD, 20/25 OS.
- Pupils: RAPD OD.
- Fundus OD: Diffuse optic disc pallor; OS normal. - OCT: Significant RNFL thinning OD, normal OS.
- Visual Field OD: Inferior altitudinal defect; stable compared with prior test.
Assessment:
- Other optic atrophy OD as a sequela of prior NAION (chronic, stable).
- No evidence of active inflammation or recurrence.
Plan:
- Continue management of vascular risk factors with PCP.
- Annual OCT and visual field monitoring.
- Patient educated about monocular precautions and low vision options.
ICD-10:
- H47.291 - Other optic atrophy, right eye
- I10 - Essential hypertension
- E11.9 - Type 2 diabetes mellitus without complications
CPT:
- 99214 - Established patient office visit (neuro-ophthalmology)
- 92133 - OCT optic nerve, unilateral/bilateral
- 92083 - Visual field (threshold), unilateral/bilateral
Billing & Compliance Pearls
- Pick the right “flavor” of optic atrophy:
- Primary → H47.21x
- Glaucomatous → H47.23x (with H40.x)
- Other (non-glaucomatous, non-primary) → H47.291-H47.299.[2][8][10]
- Always document the cause if known; payers look for a coherent story connecting optic atrophy to underlying disease.
- Use laterality-specific codes whenever available; avoid H47.299 unless the record truly lacks eye laterality.
- In SCODI/OCT claims, H47.291 is a valid supporting diagnosis if the exam is for chronic optic nerve monitoring.[9][12]
References
[1] Official ICD-10-CM entry describing H47.291 - Other optic atrophy, right eye, under “Diseases of the eye and adnexa.”[web:894]
[2] H47.29 parent category description “Other optic atrophy,” including temporal pallor and its child codes H47.291-H47.299.[web:896][web:900]
[3] ICD-10 chapter mapping showing H00-H59 as “Diseases of the eye and adnexa” and including H47 as disorders of the optic nerve and visual pathways.[web:828]
[4] Overview of disorders of optic nerve and visual pathways, including classification of optic neuropathies and atrophy patterns.[web:788][web:833]
[5] Clinical descriptions of optic neuropathies (ischemic, inflammatory, hereditary, toxic) and eventual optic atrophy as a common end stage.[web:887][web:889]
[6] Detailed clinical characteristics and pathophysiology of optic neuropathies and their visual field patterns.[web:887][web:888]
[7] Use of ophthalmoscopy and OCT to document optic nerve pallor and RNFL thinning in optic atrophy.[web:887]
[8] Coding references listing H47.291 as “Other optic atrophy, right eye” and enumerating related primary and glaucomatous atrophy codes.[web:898][web:902]
[9] Visual field defects and optic nerve imaging as key tools for documenting optic neuropathy severity and stability.[web:889][web:903]
[10] ICD-10-CM structural notes for H47.29 family, including laterality and billable status of H47.291 vs non-billable H47.29.[web:896][web:900]
[11] General description of ICD-10-CM and its expansion of laterality and eye-specific codes, including H47.x optic nerve codes.[web:855]
[12] CMS articles on scanning computerized ophthalmic diagnostic imaging (SCODI) indicating optic nerve/atrophy diagnoses as covered indications for OCT.[web:901][web:903]