ICD-10 Coding for Primary Open-Angle Glaucoma(H40.1111, H40.1123)
Complete ICD-10-CM coding and documentation guide for Primary 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 Primary Open-Angle Glaucoma
H40.11-Primary Range
Primary open-angle glaucoma
This range covers all stages and laterality of primary open-angle glaucoma.
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 POAG in the right eye with clinical validation. |
|
| H40.1123 | Primary open-angle glaucoma, left eye, severe stage | Use when documenting severe stage POAG in the left eye with clinical validation. |
|
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 primary open-angle glaucoma
Essential facts and insights about Primary Open-Angle Glaucoma
Primary ICD-10-CM Codes for primary open angle glaucoma
Decision Criteria
clinical Criteria
- Presence of mild stage indicators in the right eye
Applicable To
- Mild stage POAG in the right eye
Excludes
- Secondary glaucoma
Clinical Validation Requirements
- IOP ≥22 mmHg
- CDR ≥0.7
- RNFL thinning on OCT
Code-Specific Risks
- Incorrect staging documentation
Coding Notes
- Ensure laterality and stage are documented.
H40.1123 - Primary open-angle glaucoma, left eye, severe stage
Use when documenting severe stage POAG in the left eye with clinical validation.
Applicable To
- Severe stage POAG in the left eye
Excludes
- Secondary glaucoma
Clinical Validation Requirements
- Bilateral VF defects >12 dB MD
- Stereoscopic disc photos
Coding Notes
Ensure laterality and stage are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Low vision
H54.12-Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Primary 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: Inadequate treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use templates that prompt for stage documentation.
Impact
Reimbursement: Denial risk due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Poor data quality affecting patient records.
Mitigation Strategy
Always specify 'primary' and stage to use H40.11- codes.
Impact
Using unspecified codes increases audit risk.
Mitigation Strategy
Always document type and stage.
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 Primary Open-Angle Glaucoma, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Primary Open-Angle Glaucoma
Use these documentation templates to ensure complete and accurate documentation for Primary Open-Angle Glaucoma. These templates include all required elements for proper coding and billing.
Documenting POAG in ophthalmology
Specialty: OphthalmologyRequired Elements
- Type of glaucoma
- Laterality
- Stage
- Clinical findings
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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