ICD-10 Coding for Suspect Glaucoma(H40.01, H40.02, H40.05)
Complete ICD-10-CM coding and documentation guide for Suspect Glaucoma. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Suspect Glaucoma
H40.0Primary Range
Glaucoma suspect
This range includes codes for various types of glaucoma suspect, including open-angle and ocular hypertension.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H40.01 | Open-angle with borderline findings, low risk | Use for patients with open-angle suspect and low risk factors. |
|
| H40.02 | Open-angle with borderline findings, high risk | Use for patients with open-angle suspect and high risk factors. |
|
| H40.05 | Ocular hypertension | Use when IOP is elevated but no optic nerve damage is present. |
|
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 suspect glaucoma
Essential facts and insights about Suspect Glaucoma
Primary ICD-10-CM Codes for suspect glaucoma
Decision Criteria
clinical Criteria
- Presence of ≤2 risk factors with open-angle findings.
Applicable To
- Open-angle suspect with ≤2 risk factors
Excludes
- Confirmed glaucoma (H40.11X-)
Clinical Validation Requirements
- Thin cornea
- Family history
- Elevated IOP <28 mmHg
Code-Specific Risks
- Misclassification if risk factors are not properly documented.
Coding Notes
- Ensure documentation of risk factors and laterality.
H40.02 - Open-angle with borderline findings, high risk
Use for patients with open-angle suspect and high risk factors.
Applicable To
- Open-angle suspect with ≥3 risk factors
Excludes
- Confirmed glaucoma (H40.11X-)
Clinical Validation Requirements
- IOP ≥28 mmHg
- Cup-disc ratio >0.6
Coding Notes
Document all risk factors and laterality.
H40.05 - Ocular hypertension
Use when IOP is elevated but no optic nerve damage is present.
Applicable To
- Elevated IOP without optic nerve damage
Excludes
- Glaucoma suspect (H40.01, H40.02)
Clinical Validation Requirements
- IOP >21 mmHg
- Normal optic nerve
Coding Notes
Ensure IOP is documented without optic nerve damage.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Ocular hypertension
H40.05Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Suspect Glaucoma to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H40.01.
Impact
Clinical: Leads to incomplete patient records., Regulatory: Non-compliance with coding guidelines., Financial: Potential claim denials.
Mitigation Strategy
Always specify which eye is affected., Use templates to ensure completeness.
Impact
Reimbursement: May result in denied claims due to lack of specificity., Compliance: Non-compliance with CMS specificity requirements., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Use specific codes like H40.01 or H40.02 based on risk factors.
Impact
Using unspecified codes can lead to audit issues.
Mitigation Strategy
Use specific codes based on documented risk factors.
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 Suspect Glaucoma, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Suspect Glaucoma
Use these documentation templates to ensure complete and accurate documentation for Suspect Glaucoma. These templates include all required elements for proper coding and billing.
High-risk glaucoma suspect
Specialty: OphthalmologyRequired Elements
- Risk factors
- IOP measurements
- Optic nerve evaluation
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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