2025 ICD-10-CM code H40
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Ophthalmology - Glaucoma Diseases of the eye and adnexa Feed
Glaucoma, unspecified.
Modifiers may be applicable depending on the specific circumstances of the encounter (e.g., laterality modifiers such as OD, OS, OU, and severity modifiers if the coding system supports them). Consult the relevant coding guidelines for proper modifier usage.
Medical necessity for glaucoma coding is established by the presence of clinical findings suggestive of glaucoma. This may include elevated IOP, characteristic optic nerve changes, and visual field defects.The specific medical necessity criteria may vary depending on the payer and the type of glaucoma.
The clinical responsibility for coding H40 falls on the ophthalmologist or healthcare provider who performs the eye examination and diagnosis of glaucoma. Accurate coding requires a detailed understanding of the patient's clinical presentation, including visual field testing, intraocular pressure measurements, and optic nerve evaluation.
In simple words: This code means you have glaucoma, but the exact type isn't specified. Glaucoma is a condition where pressure inside your eye damages the optic nerve, affecting your vision. The doctor will use this code if they can't determine the exact type of glaucoma you have or if the medical records don't give enough information.
This code encompasses various types of glaucoma without specifying the subtype.It includes open-angle glaucoma, angle-closure glaucoma, and other forms of glaucoma where a more specific subtype is not documented or known.The code may be used when the type of glaucoma cannot be determined, or when the documentation does not provide enough detail for a more precise code.It is crucial to use more specific codes (like H40.0-H42.9) if sufficient clinical information is available.
Example 1: A 65-year-old patient presents with elevated intraocular pressure and visual field defects.The ophthalmologist diagnoses open-angle glaucoma but does not specify the stage. Code H40 is used., A patient with a family history of glaucoma undergoes an eye exam revealing suspicious optic nerve changes. However, the definitive diagnosis of glaucoma remains unclear; code H40.0 (Glaucoma suspect) might be utilized, instead of H40., A patient is diagnosed with glaucoma during a routine eye exam; however, the type of glaucoma is not identified due to insufficient documentation; therefore, code H40 is used.
Detailed ophthalmologic examination findings, including visual field test results (perimetry), intraocular pressure measurements (IOP), optic disc evaluation, and gonioscopy (if performed). The documentation should clearly state the diagnosis, even if a specific subtype of glaucoma is not identified.Laterality (right eye, left eye, both eyes) and severity (if possible) should also be noted.
** The unspecified nature of code H40 highlights the importance of comprehensive documentation in ophthalmologic encounters.Insufficient documentation can lead to inaccurate coding and potential reimbursement issues.
- Payment Status: Active
- Modifier TC rule: Not applicable to this diagnostic code.
- Specialties:Ophthalmology
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Ambulatory Surgical Center