ICD-10 Coding for Ocular Hypertension(H40.051, H40.052, H40.053, H40.059)
Complete ICD-10-CM coding and documentation guide for Ocular Hypertension. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Ocular Hypertension
H40.05Primary Range
Ocular hypertension
This range specifically covers ocular hypertension, distinguishing it from glaucoma and other eye conditions.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H40.051 | Ocular hypertension, right eye | Use when ocular hypertension is confirmed in the right eye with no glaucomatous damage. |
|
| H40.052 | Ocular hypertension, left eye | Use when ocular hypertension is confirmed in the left eye with no glaucomatous damage. |
|
| H40.053 | Ocular hypertension, bilateral | Use when ocular hypertension is confirmed in both eyes with no glaucomatous damage. |
|
| H40.059 | Ocular hypertension, unspecified eye | Use when ocular hypertension is confirmed but laterality is not specified. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for ocular hypertension
Essential facts and insights about Ocular Hypertension
Primary ICD-10-CM Codes for ocular hypertension
Decision Criteria
clinical Criteria
- IOP >21 mmHg in the right eye with normal optic nerve
documentation Criteria
- Document laterality and IOP measurements
Applicable To
- Elevated intraocular pressure in the right eye without glaucomatous damage
Clinical Validation Requirements
- IOP >21 mmHg in the right eye on multiple occasions
- Normal optic nerve and visual fields
Code-Specific Risks
- Risk of using unspecified codes when laterality is known
Coding Notes
- Ensure laterality is documented to avoid unspecified codes.
H40.052 - Ocular hypertension, left eye
Use when ocular hypertension is confirmed in the left eye with no glaucomatous damage.
Applicable To
- Elevated intraocular pressure in the left eye without glaucomatous damage
Excludes
- Glaucoma (H40.1-H40.9)
Clinical Validation Requirements
- IOP >21 mmHg in the left eye on multiple occasions
- Normal optic nerve and visual fields
Coding Notes
Ensure laterality is documented to avoid unspecified codes.
H40.053 - Ocular hypertension, bilateral
Use when ocular hypertension is confirmed in both eyes with no glaucomatous damage.
Applicable To
- Elevated intraocular pressure in both eyes without glaucomatous damage
Excludes
- Glaucoma (H40.1-H40.9)
Clinical Validation Requirements
- IOP >21 mmHg in both eyes on multiple occasions
- Normal optic nerve and visual fields
Coding Notes
Ensure laterality is documented to avoid unspecified codes.
H40.059 - Ocular hypertension, unspecified eye
Use when ocular hypertension is confirmed but laterality is not specified.
Applicable To
- Elevated intraocular pressure without specification of laterality
Excludes
- Glaucoma (H40.1-H40.9)
Clinical Validation Requirements
- IOP >21 mmHg without specification of laterality
- Normal optic nerve and visual fields
Coding Notes
Specify laterality to avoid using unspecified codes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Essential (primary) hypertension
I10Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Primary open-angle glaucoma, severe stage
H40.11X3Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Ocular Hypertension to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H40.051.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to insufficient documentation.
Mitigation Strategy
Ensure consistent recording of IOP over multiple visits.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audits., Data Quality: Reduces specificity and accuracy of health records.
Mitigation Strategy
Always document and code the specific eye(s) affected.
Impact
Reimbursement: Incorrect coding can affect DRG assignments., Compliance: Non-compliance with coding guidelines., Data Quality: Misclassification of patient condition.
Mitigation Strategy
Ensure documentation clearly states the absence of glaucomatous damage.
Impact
Using unspecified codes when laterality is known can trigger audits.
Mitigation Strategy
Always document and code the specific eye(s) affected.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Ocular Hypertension, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Ocular Hypertension
Use these documentation templates to ensure complete and accurate documentation for Ocular Hypertension. These templates include all required elements for proper coding and billing.
Follow-up visit for ocular hypertension
Specialty: OphthalmologyRequired Elements
- IOP measurements
- Optic nerve assessment
- Visual field results
- Laterality
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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