Regarded as one of the leading causes of irreversible blindness, glaucoma currently affects more than 3 million people in the United States. Reports from the National Eye Institute show that this number will reach 4.2 million by the end of 2030. A group of eye conditions, glaucoma causes damage to the optic nerves which connect the eye to the brain. Damage in the optic nerves is often caused by an abnormally high pressure in the eyes and may result in partial vision loss or blindness. If detected at an early stage, vision loss can be slowed or prevented. Conducting regular eye examinations can help detect and prevent the condition in the long run. Billing and coding for ophthalmology conditions can be challenging. Proper physician documentation can ensure accurate ophthalmology medical coding using the correct medical codes, better patient care, and on-time reimbursement.
Glaucoma can occur at any age, but is more common among older adults above the age of 60 years. Usually, it affects both eyes, although one may be more severely affected than the other. Glaucoma consists of several types like – open-angle glaucoma, closed-angle glaucoma, low-tension glaucoma and pigmentary glaucoma. The exact factors that cause different types glaucoma are unknown. But certain health conditions like – tumor, diabetes, hypothyroidism, an advanced cataract, or inflammation – can increase the risk of this condition. Symptoms of this condition include – severe headache, eye pain, blurred vision, eye redness, halos around the eyes and tunnel vision in the advanced stages.
Diagnosis of this condition involves a medical history evaluation and a comprehensive eye examination including vision loss tests, optical nerve damage testing and measurement of intraocular pressure. The damage caused by glaucoma can’t be reversed. However, treatment and regular checkups can help slow or prevent vision loss, especially if the disease is identified in its early stages. Treatment involves a combination of oral medications and other surgical therapies.
Coding Guidelines for Glaucoma
As mentioned above, there are different types of glaucoma wherein open-angle and angle closure glaucoma are the most common and important types. According the National Eye Institute (NEI), open-angle (chronic) glaucoma is the most common type which has no signs or symptoms except gradual vision loss. This loss may be so slow that your vision can suffer irreparable damage before any other signs become apparent. Acute angle-closure glaucoma is an emergency type that occurs quickly within minutes or hours within the occurrence of an injury, whereas chronic angle-closure glaucoma can occur due to a defect caused by an illness or age.
Accurate ophthalmology medical coding accompanied by proper physician documentation can ensure better patient care and on-time reimbursement. Here discussed are some of the coding guidelines for glaucoma –
- Assign appropriate glaucoma diagnosis codes (H40 category) to identify the type of glaucoma, the affected eye (including its laterality – left, right or bilateral) and the exact stage of glaucoma. The 6th digit indicates the extent of laterality.
- Consider the different stages of eye condition. The stage of glaucoma is denoted in the 7th of last digit of the code. The different stages of glaucoma are classified as –
- Stage 0 – Unspecified
- Stage 1 – Mild
- Stage 2 – Moderate
- Stage 3 – Severe
- Stage 4 -Indeterminate
- When a person has bilateral glaucoma that is documented as the same type and stage, a code for glaucoma is assigned with the appropriate seventh character for the stage.
- When a person has bilateral glaucoma of different type of different stage, a specific code is assigned for each eye, instead of a bilateral code. In fact, there are specific guidelines for different sub-categories – H40.10-, H40.11-, and H40.20- (I.C.7.a.), with attention to how the codes are indexed in the Alphabetic Index.
- If a patient is admitted with glaucoma and the stage progresses during the admission, the code for highest stage documented must be assigned.
ICD-10 Codes for Glaucoma
- H40 Glaucoma
- H40.0 Glaucoma suspect
- H40.00 Preglaucoma, unspecified
- H40.01 Open angle with borderline findings, low risk
- H40.02 Open angle with borderline findings, high risk
- H40.03 Anatomical narrow angle
- H40.04 Steroid responder
- H40.05 Ocular hypertension
- H40.06 Primary angle closure without glaucoma damage
- H40.1 Open-angle glaucoma
- H40.10 Unspecified open-angle glaucoma
- H40.11 Primary open-angle glaucoma
- H40.12 Low-tension glaucoma
- H40.13 Pigmentary glaucoma
- H40.14 Capsular glaucoma with pseudoexfoliation of lens
- H40.15 Residual stage of open-angle glaucoma
- H40.2 Primary angle-closure glaucoma
- H40.20 Unspecified primary angle-closure glaucoma
- H40.21 Acute angle-closure glaucoma
- H40.22 Chronic angle-closure glaucoma
- H40.23 Intermittent angle-closure glaucoma
- H40.24 Residual stage of angle-closure glaucoma
- H40.3 Glaucoma secondary to eye trauma
- H40.30 Glaucoma secondary to eye trauma, unspecified eye
- H40.31 Glaucoma secondary to eye trauma, right eye
- H40.32 Glaucoma secondary to eye trauma, left eye
- H40.33 Glaucoma secondary to eye trauma, bilateral
- H40.4 Glaucoma secondary to eye inflammation
- H40.40 Glaucoma secondary to eye inflammation, unspecified eye
- H40.41 Glaucoma secondary to eye inflammation, right eye
- H40.42 Glaucoma secondary to eye inflammation, left eye
- H40.43 Glaucoma secondary to eye inflammation, bilateral
- H40.5 Glaucoma secondary to other eye disorders
- H40.50 Glaucoma secondary to other eye disorders, unspecified eye
- H40.51 Glaucoma secondary to other eye disorders, right eye
- H40.52 Glaucoma secondary to other eye disorders, left eye
- H40.53 Glaucoma secondary to other eye disorders, bilateral
- H40.6 Glaucoma secondary to drugs
- H40.60 Glaucoma secondary to drugs, unspecified eye
- H40.61 Glaucoma secondary to drugs, right eye
- H40.62 Glaucoma secondary to drugs, left eye
- H40.63 Glaucoma secondary to drugs, bilateral
- H40.8 Other glaucoma
- H40.81 Glaucoma with increased episcleral venous pressure
- H40.82 Hypersecretion glaucoma
- H40.83 Aqueous misdirection
- H40.89 Other specified glaucoma
- H40.9 Unspecified glaucoma
Glaucoma cannot be fully prevented, but it is still important to catch it early so that the treatment can be initiated. The best way to catch any type of glaucoma early is to have an annual preventive eye care appointment.
With proper clinical documentation, coders in a medical billing company can help physicians report different types of glaucoma using the right codes. Proper medical code selection is essential to maximize reimbursement and avoid denials.
Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.