2025 ICD-10-CM code H40.1
(Active) Effective Date: N/A Diseases of the eye and adnexa - Glaucoma 7 Feed
Open-angle glaucoma.
Medical necessity for services related to H40.1 is established by the presence of signs and symptoms of open-angle glaucoma and the need for ongoing monitoring and treatment to prevent or slow vision loss. Payers generally require documentation that supports the diagnosis and justifies the medical interventions being provided.
Diagnosis and management of open-angle glaucoma typically falls under the purview of ophthalmologists. They perform comprehensive eye exams to assess intraocular pressure, optic nerve health, and visual fields. Treatment strategies often involve medications to lower eye pressure, laser procedures, or surgery. Regular monitoring and follow-up care are essential to manage the disease and prevent vision loss.
In simple words: Open-angle glaucoma is a type of eye disease where the eye's drainage system doesn't work correctly, causing pressure buildup inside the eye. This pressure can damage the optic nerve, potentially leading to vision problems.
Open-angle glaucoma is a condition where the drainage angle of the eye remains open, but the trabecular meshwork is partially blocked, slowing the normal drainage of fluid from the eye. This can lead to increased intraocular pressure and potential damage to the optic nerve, which can result in vision loss. Several subtypes of open-angle glaucoma exist including primary open angle glaucoma (POAG), low-tension glaucoma (LTG), normal-tension glaucoma (NTG), and pigmentary glaucoma.
Example 1: A 65-year-old patient presents with gradual vision loss and elevated intraocular pressure. Upon examination, the ophthalmologist diagnoses primary open-angle glaucoma., A 50-year-old patient with a family history of glaucoma is diagnosed with open-angle glaucoma during a routine eye exam, even though they have no noticeable symptoms yet., A 40-year-old patient experiences pigment dispersion syndrome, leading to pigmentary glaucoma, a type of open-angle glaucoma.
Documentation for H40.1 should include intraocular pressure measurements, visual field test results, optic nerve assessment (e.g., using ophthalmoscopy or OCT), and details of any treatment provided, such as medications or surgical interventions.It is also important to document the type of open-angle glaucoma, such as primary open-angle glaucoma, normal-tension glaucoma, or pigmentary glaucoma.
** Excludes1: absolute glaucoma (H44.51-), congenital glaucoma (Q15.0), traumatic glaucoma due to birth injury (P15.3). Excludes2: certain conditions originating in the perinatal period (P04-P96), certain infectious and parasitic diseases (A00-B99), complications of pregnancy, childbirth, and the puerperium (O00-O9A), congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99), diabetes mellitus-related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-), endocrine, nutritional and metabolic diseases (E00-E88), injury (trauma) of eye and orbit (S05.-), injury, poisoning and certain other consequences of external causes (S00-T88), neoplasms (C00-D49), symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94), syphilis-related eye disorders (A50.01, A50.3-, A51.43, A52.71).
- Specialties:Ophthalmology, Optometry
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital (if surgery or other inpatient procedures are performed)