ICD-10 Coding for Open-Angle Glaucoma(H40.1111, H40.1133)
Complete ICD-10-CM coding and documentation guide for Open-Angle Glaucoma. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Open-Angle Glaucoma
H40.11-H40.12Primary Range
Primary open-angle glaucoma and low-tension glaucoma
This range includes the primary codes for open-angle glaucoma, specifying laterality and stage.
Glaucoma suspect
Used for patients suspected of having glaucoma based on risk factors but without confirmed optic nerve damage.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H40.1111 | Primary open-angle glaucoma, right eye, mild stage | Use when documenting mild stage primary open-angle glaucoma in the right eye. |
|
| H40.1133 | Primary open-angle glaucoma, bilateral, severe stage | Use when documenting severe stage primary open-angle glaucoma affecting both eyes. |
|
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 open-angle glaucoma
Essential facts and insights about Open-Angle Glaucoma
Primary ICD-10-CM Codes for open angle glaucoma
Decision Criteria
clinical Criteria
- Presence of elevated IOP and optic nerve changes
documentation Criteria
- Document laterality and stage explicitly
Applicable To
- Mild stage primary open-angle glaucoma affecting the right eye
Clinical Validation Requirements
- IOP >21mmHg
- Optic nerve head changes
- Visual field defects
Code-Specific Risks
- Ensure laterality and stage are documented to avoid unspecified coding.
Coding Notes
- Ensure documentation includes specific stage and laterality.
H40.1133 - Primary open-angle glaucoma, bilateral, severe stage
Use when documenting severe stage primary open-angle glaucoma affecting both eyes.
Applicable To
- Severe stage primary open-angle glaucoma affecting both eyes
Excludes
- Secondary glaucoma (H40.5-H40.6)
Clinical Validation Requirements
- IOP >21mmHg
- Severe optic nerve damage
- Significant visual field loss
Coding Notes
Ensure documentation includes specific stage and laterality.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of agents affecting the immune system
Z79.82Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Open-Angle Glaucoma to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H40.1111.
Impact
Clinical: Inaccurate clinical records., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Use templates that prompt for stage documentation., Educate staff on the importance of complete documentation.
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Always document and code the specific type, laterality, and stage of glaucoma.
Impact
Failure to document all necessary elements for glaucoma coding.
Mitigation Strategy
Use comprehensive templates and conduct regular audits.
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 Open-Angle Glaucoma, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Open-Angle Glaucoma
Use these documentation templates to ensure complete and accurate documentation for Open-Angle Glaucoma. These templates include all required elements for proper coding and billing.
Routine glaucoma follow-up
Specialty: OphthalmologyRequired Elements
- Patient history
- IOP measurement
- Optic nerve evaluation
- Visual field test results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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