ICD-10 Coding for Glaucoma Right Eye(H40.1111, H40.1112, H40.1113)
Complete ICD-10-CM coding and documentation guide for Glaucoma Right Eye. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Glaucoma Right Eye
H40.1-H40.2Primary Range
Glaucoma codes specifying type and laterality
This range includes codes for primary open-angle glaucoma with specific laterality and staging.
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 the patient has mild primary open-angle glaucoma in the right eye with documented IOP and visual field loss. |
|
| H40.1112 | Primary open-angle glaucoma, right eye, moderate stage | Use when the patient has moderate primary open-angle glaucoma in the right eye with documented IOP and visual field loss. |
|
| H40.1113 | Primary open-angle glaucoma, right eye, severe stage | Use when the patient has severe primary open-angle glaucoma in the right eye with documented IOP and visual field loss. |
|
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 glaucoma right eye
Essential facts and insights about Glaucoma Right Eye
Primary ICD-10-CM Codes for glaucoma right eye
Decision Criteria
clinical Criteria
- Mild visual field loss and RNFL thinning
Applicable To
- Mild stage glaucoma in the right eye
Clinical Validation Requirements
- IOP 21-25 mmHg
- MD -2 to -6 dB on visual field
- RNFL thickness 80-95 μm
Code-Specific Risks
- Incorrect staging can lead to improper code selection.
Coding Notes
- Ensure documentation includes both structural and functional evidence for accurate staging.
H40.1112 - Primary open-angle glaucoma, right eye, moderate stage
Use when the patient has moderate primary open-angle glaucoma in the right eye with documented IOP and visual field loss.
Applicable To
- Moderate stage glaucoma in the right eye
Excludes
- Glaucoma suspect (H40.00-)
- Ocular hypertension (H40.05-)
Clinical Validation Requirements
- IOP 26-30 mmHg
- MD -6 to -12 dB on visual field
- RNFL thickness 70-79 μm
Coding Notes
Ensure documentation includes both structural and functional evidence for accurate staging.
H40.1113 - Primary open-angle glaucoma, right eye, severe stage
Use when the patient has severe primary open-angle glaucoma in the right eye with documented IOP and visual field loss.
Applicable To
- Severe stage glaucoma in the right eye
Excludes
- Glaucoma suspect (H40.00-)
- Ocular hypertension (H40.05-)
Clinical Validation Requirements
- IOP >30 mmHg
- MD ≤-12 dB on visual field
- RNFL thickness <70 μm
Coding Notes
Ensure documentation includes both structural and functional evidence for accurate staging.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Scanning computerized ophthalmic imaging
92133Differential 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 Glaucoma Right Eye to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H40.1111.
Impact
Clinical: May lead to incorrect treatment decisions., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always specify 'right eye' in documentation., Use templates that prompt for laterality.
Impact
Reimbursement: May lead to reduced reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Impacts the accuracy of clinical data.
Mitigation Strategy
Always use specific codes that reflect the documented stage of glaucoma.
Impact
High error rates in audits due to unspecified codes when staging is documented.
Mitigation Strategy
Use specific codes that reflect the documented stage of glaucoma.
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 Glaucoma Right Eye, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Glaucoma Right Eye
Use these documentation templates to ensure complete and accurate documentation for Glaucoma Right Eye. These templates include all required elements for proper coding and billing.
Routine glaucoma follow-up
Specialty: OphthalmologyRequired Elements
- Patient history
- IOP measurements
- Visual field test results
- OCT RNFL analysis
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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