Coding Tips: Bilateral glaucoma with same type and stage

Glaucoma is an eye disease that damages your eye’s optic nerve. It is often called the “silent thief of sight” because most of its types typically cause no pain and produce no symptoms until noticeable vision loss occurs.

Intraocular pressure (IOP): It is a measurement of the fluid pressure inside the eye. An increase in intraocular pressure can damage the optic nerves that supplies visual information to the brain from eyes resulting in glaucoma condition. If the damage worsens, glaucoma can cause permanent vision loss or even total blindness within a few years.

Types of Glaucoma:

Open-angle glaucoma: (Primary or chronic glaucoma):

  • Caused by the slow clogging of the drainage canals, resulting in increased eye pressure.
  • Has a wide and open angle between the iris and cornea.

Angle-closure glaucoma: (Acute glaucoma or narrow-angle glaucoma)

  • Caused by blocked drainage canals, resulting in a sudden rise in intraocular pressure.
  • Has a closed or narrow angle between the iris and cornea.

Normal tension glaucoma: (low-tension or normal-pressure glaucoma)

  • In normal-tension glaucoma the optic nerve is damaged even though the eye pressure is not very high and the reason is unknown.

Congenital Glaucoma

  • · This type of glaucoma occurs in babies when there is incorrect or incomplete development of the eye’s drainage canals during the prenatal period

Other Types of Glaucoma:

Variants of open-angle and angle-closure glaucoma include:

  • Secondary glaucoma
  • Pigmentary glaucoma
  • Pseudoexfoliative glaucoma
  • Traumatic glaucoma
  • Neovascular glaucoma
  • Iridi Corneal Endothelial Syndrome (ICE)
  • Uveitic glaucoma

Coding tips for glaucoma:

Assign appropriate glaucoma diagnosis codes (H40-H42) to identify the following:

  • Type of glaucoma
  • The affected eye (laterality – left, right or bilateral)
  • Glaucoma stage

Laterality: Laterality is an important factor when assigning codes for glaucoma. You can see the specific codes for the right eye, left eye and bilateral (both eyes). Most of the ophthalmologic reports would state OD-oculus dexter (right eye), OS- oculus sinister(left eye), or OU-oculus utro(both eyes) rather than right, left or bilateral. ICD-10-CM assigns the code number for laterality as follows:

  • 1–is the right eye
  • 2–is the left eye
  • 3–indicates bilateral
  • 9–means the side is unspecified

Bilateral glaucoma with same type and stage:

When a patient has bilateral glaucoma with same type and stage, you need to assign the codes based on the laterality codes available in the ICD-10 CM classification.

Scenario: 1

Patient has bilateral glaucoma with same type and stage and the classification provides code for bilateral glaucoma.

In this scenario, you need to report only the code for the type of glaucoma, bilateral with the seventh character for the stage.

Example: A patient is suffering from primary open-angle glaucoma of both the eyes with moderate stage of both.

You need to report code H40.1132 and the break-up is given below:

Scenario: 2

Patient has bilateral glaucoma with same type and stage and the classification does not provide code for bilateral glaucoma.

In this scenario, you need to report only one code for the type of glaucoma with the appropriate seventh character for the stage.

Example: Categories H40.10 (Unspecified open angle glaucoma) and H40.20 (Unspecified primary angle-closure glaucoma) with moderate stage

You need to report code H40.10X2 and the break-up is given below:

I have discussed only the coding tips for bilateral glaucoma with same type and same stage in this blog post. The coding tips for bilateral glaucoma with different type and /or different stage will be discussed in detail in another post.

Happy learning! Happy coding!

References:

https://www.aao.org/Assets/5adb14a6-7e5d-42ea-af51-3db772c4b0c2/636713219263270000/bc-2568-update-icd-10-quick-reference-guides-glaucoma-final-v2-color-pdf?inline=1
https://www.healthicity.com/blog/icd-10-reminder-series-section-1c7-disease-eye-adnexa.

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