Question

How do the coding guidelines for glaucoma change if the patient has glaucoma in both eyes? Can one code be assigned? Why or why not? And must be at least 250 words

Answer 1

Coding guidelines for glaucoma

Coding for Glaucoma

Glaucoma is actually a group of eye diseases that damage the optic nerve and can lead to blindness. The optic nerve is damaged by increased ocular pressure. The two main types of glaucoma are open angle (chronic) and closed angle (acute).

Types of Glaucoma

Primary open-angle glaucoma (365.11) is when the drainage channels are partially obstructed and cause the slow drainage of fluid from the eye.

Acute angle-closure glaucoma, also called closed-angle glaucoma, is when the drainage angle is blocked.

The glaucoma section codes begin with H40 “glaucoma” or H42 “glaucoma in diseases classified elsewhere.”

ICD-10

For ICD-10, not all glaucoma diagnoses require the use of Staging at the 7th digit.

These are the Codes in ICD-10 that do not have a laterality digit: Code the Stage for the most severely affected eye, if required in the 7th digit.

1. Unspecified open-angle glaucoma H40.10- (Requires Stage digit for most severely affected eye)

2. Unspecified primary angle-closure glaucoma H40.20- (Requires Stage digit for most severely affected eye)

3. Other specified glaucoma H40.89 (Stage is not used)

4. Unspecified glaucoma H40.9 (Stage is not used)

• When a patient has bilateral glaucoma and the physician documents both eyes as being the same type and stage, and the classification does not provide a code for bilateral glaucoma (i.e., subcategories H40.10, H40.11, and H40.20) report only one code for the type of glaucoma with the appropriate seventh character for the stage.
• When a patient has bilateral glaucoma and the physician documents that each eye has a different type or stage, and the classification distinguishes laterality, assign the appropriate code for each eye rather than the code for bilateral glaucoma.

Laterality and staging.

Not all codes have laterality. Not all codes require staging. When laterality is required, you usually report it in the code’s sixth position (e.g., H40.03-)—very occasionally in the fifth position (e.g., H46.0-)—using the following:

• 1 for the right eye
• 2 for the left
• 3 for both

When staging is required, report it in the code’s seventh position (e.g., H40.141-), using the following:

• 0 for stage unspecified
• 1 for mild
• 2 for moderate
• 3 for severe
• 4 for indeterminate

Example: Staging with laterality. H40.2213 is the code for chronic angle-closure glaucoma in the right eye, severe stage, with the sixth position indicating laterality (1 for right eye) and the seventh position indicating stage (3 for severe stage).

Example: Staging without laterality. H40.11X3 is the code for primary open-angle glaucoma (POAG), severe stage. Why the X? The POAG codes require a staging indicator, which must go in the seventh position. However, the POAG codes don’t have laterality, which means there is no laterality indicator to fill the sixth position—instead, you use an X as a placeholder.

If no laterality :

If no laterality. When a diagnosis code does not have laterality, you should code the eye with the more severe stage of glaucoma.

Link to the CPT code. As with ICD-9, you must link the appropriate ICD-10 code to the specific CPT code. This step is just as critical as it was with ICD-9.

Example: CPT code 92133. When you report CPT code 92133—which is the code for scanning computerized ophthalmic diagnostic imaging (SCODI)—you can choose from more than 150 glaucoma-related ICD-10 codes, ranging from H21.551 Recession of chamber angle, right eye to Q15.0 Congenital glaucoma

Watch for Excludes1 notes. These flag diagnosis codes that can’t be reported in the same eye at the same time.

Example: H40.06. The code for primary angle closure without glaucoma damage (H40.06-) is covered by an Excludes1 note. This indicates that if you report H40.06-, you can’t also report absolute glaucoma (H44.51-), congenital glaucoma (Q15.0), or traumatic glaucoma due to birth injury (P15.3) for the same eye on the same day.