ICD-10 Coding for Suspected Glaucoma(H40.00X, H40.01X, H40.02X, H40.05X)
Complete ICD-10-CM coding and documentation guide for Suspected Glaucoma. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Suspected Glaucoma
H40.00-H40.05Primary Range
Glaucoma suspect codes
These codes cover various forms of suspected glaucoma, including ocular hypertension and borderline findings.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H40.00X | Unspecified pre-glaucoma | Use when no specific findings or risk factors are documented. |
|
| H40.01X | Open-angle with borderline findings, low risk | Use when there are borderline findings with low risk factors. |
|
| H40.02X | Open-angle with borderline findings, high risk | Use when there are borderline findings with high risk factors. |
|
| H40.05X | Ocular hypertension | Use when IOP is elevated but without optic nerve or visual field changes. |
|
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 suspected glaucoma
Essential facts and insights about Suspected Glaucoma
Primary ICD-10-CM Codes for suspected glaucoma
Decision Criteria
coding Criteria
- Use only when no specific findings are documented.
Applicable To
- Generic glaucoma suspect without specific findings
Clinical Validation Requirements
- General suspicion of glaucoma without documented risk factors
Code-Specific Risks
- Claim denials due to lack of specificity
Coding Notes
- Avoid using this code if specific risk factors or findings are documented.
H40.01X - Open-angle with borderline findings, low risk
Use when there are borderline findings with low risk factors.
Applicable To
- Elevated IOP or suspicious optic nerve without visual field loss
Excludes
- High-risk glaucoma suspect (H40.02X)
Clinical Validation Requirements
- Elevated IOP or suspicious optic nerve
- 1-2 risk factors such as age >60 or African ancestry
Coding Notes
Ensure documentation of specific risk factors.
H40.02X - Open-angle with borderline findings, high risk
Use when there are borderline findings with high risk factors.
Applicable To
- Elevated IOP and optic nerve changes with ≥3 risk factors
Excludes
- Low-risk glaucoma suspect (H40.01X)
Clinical Validation Requirements
- Elevated IOP and optic nerve changes
- ≥3 risk factors such as diabetes, family history, or thin cornea
Coding Notes
Document all risk factors clearly.
H40.05X - Ocular hypertension
Use when IOP is elevated but without optic nerve or visual field changes.
Applicable To
- IOP >21 mmHg in ≥2 readings without optic nerve/visual field abnormalities
Excludes
- Glaucoma with optic nerve damage
Clinical Validation Requirements
- IOP >21 mmHg in ≥2 readings
Coding Notes
Ensure IOP readings are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Suspected Glaucoma to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H40.00X.
Impact
Clinical: Inaccurate risk assessment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure all risk factors are documented in the patient's record.
Impact
Reimbursement: Claims may be denied due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Poor data quality and inaccurate patient records.
Mitigation Strategy
Use specific codes like H40.01X or H40.02X based on documented findings.
Impact
Using non-specific codes can trigger audits.
Mitigation Strategy
Ensure documentation supports the specific code used.
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 Suspected Glaucoma, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Suspected Glaucoma
Use these documentation templates to ensure complete and accurate documentation for Suspected Glaucoma. These templates include all required elements for proper coding and billing.
Patient with elevated IOP and family history
Specialty: OphthalmologyRequired Elements
- IOP measurements
- Optic nerve assessment
- Risk factors
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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