Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 11.05.16h


Attachment:A

Policy #:11.05.16h

Description:ICD-10 codes

Title:Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



INSERTION OF AQUEOUS SHUNTS ARE MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES:

H40.10X0 Unspecified open-angle glaucoma, stage unspecified

H40.10X1 Unspecified open-angle glaucoma, mild stage

H40.10X2 Unspecified open-angle glaucoma, moderate stage

H40.10X3 Unspecified open-angle glaucoma, severe stage

H40.10X4 Unspecified open-angle glaucoma, indeterminate stage

H40.1110 Primary open-angle glaucoma, right eye, stage unspecified

H40.1111 Primary open-angle glaucoma, right eye, mild stage

H40.1112 Primary open-angle glaucoma, right eye, moderate stage

H40.1113 Primary open-angle glaucoma, right eye, severe stage

H40.1114 Primary open-angle glaucoma, right eye, indeterminate stage

H40.1120 Primary open-angle glaucoma, left eye, stage unspecified

H40.1121 Primary open-angle glaucoma, left eye, mild stage

H40.1122 Primary open-angle glaucoma, left eye, moderate stage

H40.1123 Primary open-angle glaucoma, left eye, severe stage

H40.1124 Primary open-angle glaucoma, left eye, indeterminate stage

H40.1130 Primary open-angle glaucoma, bilateral, stage unspecified

H40.1131 Primary open-angle glaucoma, bilateral, mild stage

H40.1132 Primary open-angle glaucoma, bilateral, moderate stage

H40.1133 Primary open-angle glaucoma, bilateral, severe stage

H40.1134 Primary open-angle glaucoma, bilateral, indeterminate stage

H40.1190 Primary open-angle glaucoma, unspecified eye, stage unspecified

H40.1191 Primary open-angle glaucoma, unspecified eye, mild stage

H40.1192 Primary open-angle glaucoma, unspecified eye, moderate stage

H40.1193 Primary open-angle glaucoma, unspecified eye, severe stage

H40.1194 Primary open-angle glaucoma, unspecified eye, indeterminate stage

H40.1210 Low-tension glaucoma, right eye, stage unspecified

H40.1211 Low-tension glaucoma, right eye, mild stage

H40.1212 Low-tension glaucoma, right eye, moderate stage

H40.1213 Low-tension glaucoma, right eye, severe stage

H40.1214 Low-tension glaucoma, right eye, indeterminate stage

H40.1220 Low-tension glaucoma, left eye, stage unspecified

H40.1221 Low-tension glaucoma, left eye, mild stage

H40.1222 Low-tension glaucoma, left eye, moderate stage

H40.1223 Low-tension glaucoma, left eye, severe stage

H40.1224 Low-tension glaucoma, left eye, indeterminate stage

H40.1230 Low-tension glaucoma, bilateral, stage unspecified

H40.1231 Low-tension glaucoma, bilateral, mild stage

H40.1232 Low-tension glaucoma, bilateral, moderate stage

H40.1233 Low-tension glaucoma, bilateral, severe stage

H40.1234 Low-tension glaucoma, bilateral, indeterminate stage

H40.1290 Low-tension glaucoma, unspecified eye, stage unspecified

H40.1291 Low-tension glaucoma, unspecified eye, mild stage

H40.1292 Low-tension glaucoma, unspecified eye, moderate stage

H40.1293 Low-tension glaucoma, unspecified eye, severe stage

H40.1294 Low-tension glaucoma, unspecified eye, indeterminate stage

H40.1310 Pigmentary glaucoma, right eye, stage unspecified

H40.1311 Pigmentary glaucoma, right eye, mild stage

H40.1312 Pigmentary glaucoma, right eye, moderate stage

H40.1313 Pigmentary glaucoma, right eye, severe stage

H40.1314 Pigmentary glaucoma, right eye, indeterminate stage

H40.1320 Pigmentary glaucoma, left eye, stage unspecified

H40.1321 Pigmentary glaucoma, left eye, mild stage

H40.1322 Pigmentary glaucoma, left eye, moderate stage

H40.1323 Pigmentary glaucoma, left eye, severe stage

H40.1324 Pigmentary glaucoma, left eye, indeterminate stage

H40.1330 Pigmentary glaucoma, bilateral, stage unspecified

H40.1331 Pigmentary glaucoma, bilateral, mild stage

H40.1332 Pigmentary glaucoma, bilateral, moderate stage

H40.1333 Pigmentary glaucoma, bilateral, severe stage

H40.1334 Pigmentary glaucoma, bilateral, indeterminate stage

H40.1390 Pigmentary glaucoma, unspecified eye, stage unspecified

H40.1391 Pigmentary glaucoma, unspecified eye, mild stage

H40.1392 Pigmentary glaucoma, unspecified eye, moderate stage

H40.1393 Pigmentary glaucoma, unspecified eye, severe stage

H40.1394 Pigmentary glaucoma, unspecified eye, indeterminate stage

H40.1410 Capsular glaucoma with pseudoexfoliation of lens, right eye, stage unspecified

H40.1411 Capsular glaucoma with pseudoexfoliation of lens, right eye, mild stage

H40.1412 Capsular glaucoma with pseudoexfoliation of lens, right eye, moderate stage

H40.1413 Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage

H40.1414 Capsular glaucoma with pseudoexfoliation of lens, right eye, indeterminate stage

H40.1420 Capsular glaucoma with pseudoexfoliation of lens, left eye, stage unspecified

H40.1421 Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stage

H40.1422 Capsular glaucoma with pseudoexfoliation of lens, left eye, moderate stage

H40.1423 Capsular glaucoma with pseudoexfoliation of lens, left eye, severe stage

H40.1424 Capsular glaucoma with pseudoexfoliation of lens, left eye, indeterminate stage

H40.1430 Capsular glaucoma with pseudoexfoliation of lens, bilateral, stage unspecified

H40.1431 Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stage

H40.1432 Capsular glaucoma with pseudoexfoliation of lens, bilateral, moderate stage

H40.1433 Capsular glaucoma with pseudoexfoliation of lens, bilateral, severe stage

H40.1434 Capsular glaucoma with pseudoexfoliation of lens, bilateral, indeterminate stage

H40.1490 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, stage unspecified

H40.1491 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, mild stage

H40.1492 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, moderate stage

H40.1493 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, severe stage

H40.1494 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, indeterminate stage

H40.151 Residual stage of open-angle glaucoma, right eye

H40.152 Residual stage of open-angle glaucoma, left eye

H40.153 Residual stage of open-angle glaucoma, bilateral

H40.159 Residual stage of open-angle glaucoma, unspecified eye

H40.20X0 Unspecified primary angle-closure glaucoma, stage unspecified

H40.20X1 Unspecified primary angle-closure glaucoma, mild stage

H40.20X2 Unspecified primary angle-closure glaucoma, moderate stage

H40.20X3 Unspecified primary angle-closure glaucoma, severe stage

H40.20X4 Unspecified primary angle-closure glaucoma, indeterminate stage

H40.211 Acute angle-closure glaucoma, right eye

H40.212 Acute angle-closure glaucoma, left eye

H40.213 Acute angle-closure glaucoma, bilateral

H40.219 Acute angle-closure glaucoma, unspecified eye

H40.2210 Chronic angle-closure glaucoma, right eye, stage unspecified

H40.2211 Chronic angle-closure glaucoma, right eye, mild stage

H40.2212 Chronic angle-closure glaucoma, right eye, moderate stage

H40.2213 Chronic angle-closure glaucoma, right eye, severe stage

H40.2214 Chronic angle-closure glaucoma, right eye, indeterminate stage

H40.2220 Chronic angle-closure glaucoma, left eye, stage unspecified

H40.2221 Chronic angle-closure glaucoma, left eye, mild stage

H40.2222 Chronic angle-closure glaucoma, left eye, moderate stage

H40.2223 Chronic angle-closure glaucoma, left eye, severe stage

H40.2224 Chronic angle-closure glaucoma, left eye, indeterminate stage

H40.2230 Chronic angle-closure glaucoma, bilateral, stage unspecified

H40.2231 Chronic angle-closure glaucoma, bilateral, mild stage

H40.2232 Chronic angle-closure glaucoma, bilateral, moderate stage

H40.2233 Chronic angle-closure glaucoma, bilateral, severe stage

H40.2234 Chronic angle-closure glaucoma, bilateral, indeterminate stage

H40.2290 Chronic angle-closure glaucoma, unspecified eye, stage unspecified

H40.2291 Chronic angle-closure glaucoma, unspecified eye, mild stage

H40.2292 Chronic angle-closure glaucoma, unspecified eye, moderate stage

H40.2293 Chronic angle-closure glaucoma, unspecified eye, severe stage

H40.2294 Chronic angle-closure glaucoma, unspecified eye, indeterminate stage

H40.231 Intermittent angle-closure glaucoma, right eye

H40.232 Intermittent angle-closure glaucoma, left eye

H40.233 Intermittent angle-closure glaucoma, bilateral

H40.239 Intermittent angle-closure glaucoma, unspecified eye

H40.241 Residual stage of angle-closure glaucoma, right eye

H40.242 Residual stage of angle-closure glaucoma, left eye

H40.243 Residual stage of angle-closure glaucoma, bilateral

H40.249 Residual stage of angle-closure glaucoma, unspecified eye

H40.30X0 Glaucoma secondary to eye trauma, unspecified eye, stage unspecified

H40.30X1 Glaucoma secondary to eye trauma, unspecified eye, mild stage

H40.30X2 Glaucoma secondary to eye trauma, unspecified eye, moderate stage

H40.30X3 Glaucoma secondary to eye trauma, unspecified eye, severe stage

H40.30X4 Glaucoma secondary to eye trauma, unspecified eye, indeterminate stage

H40.31X0 Glaucoma secondary to eye trauma, right eye, stage unspecified

H40.31X1 Glaucoma secondary to eye trauma, right eye, mild stage

H40.31X2 Glaucoma secondary to eye trauma, right eye, moderate stage

H40.31X3 Glaucoma secondary to eye trauma, right eye, severe stage

H40.31X4 Glaucoma secondary to eye trauma, right eye, indeterminate stage

H40.32X0 Glaucoma secondary to eye trauma, left eye, stage unspecified

H40.32X1 Glaucoma secondary to eye trauma, left eye, mild stage

H40.32X2 Glaucoma secondary to eye trauma, left eye, moderate stage

H40.32X3 Glaucoma secondary to eye trauma, left eye, severe stage

H40.32X4 Glaucoma secondary to eye trauma, left eye, indeterminate stage

H40.33X0 Glaucoma secondary to eye trauma, bilateral, stage unspecified

H40.33X1 Glaucoma secondary to eye trauma, bilateral, mild stage

H40.33X2 Glaucoma secondary to eye trauma, bilateral, moderate stage

H40.33X3 Glaucoma secondary to eye trauma, bilateral, severe stage

H40.33X4 Glaucoma secondary to eye trauma, bilateral, indeterminate stage

H40.40X0 Glaucoma secondary to eye inflammation, unspecified eye, stage unspecified

H40.40X1 Glaucoma secondary to eye inflammation, unspecified eye, mild stage

H40.40X2 Glaucoma secondary to eye inflammation, unspecified eye, moderate stage

H40.40X3 Glaucoma secondary to eye inflammation, unspecified eye, severe stage

H40.40X4 Glaucoma secondary to eye inflammation, unspecified eye, indeterminate stage

H40.41X0 Glaucoma secondary to eye inflammation, right eye, stage unspecified

H40.41X1 Glaucoma secondary to eye inflammation, right eye, mild stage

H40.41X2 Glaucoma secondary to eye inflammation, right eye, moderate stage

H40.41X3 Glaucoma secondary to eye inflammation, right eye, severe stage

H40.41X4 Glaucoma secondary to eye inflammation, right eye, indeterminate stage

H40.42X0 Glaucoma secondary to eye inflammation, left eye, stage unspecified

H40.42X1 Glaucoma secondary to eye inflammation, left eye, mild stage

H40.42X2 Glaucoma secondary to eye inflammation, left eye, moderate stage

H40.42X3 Glaucoma secondary to eye inflammation, left eye, severe stage

H40.42X4 Glaucoma secondary to eye inflammation, left eye, indeterminate stage

H40.43X0 Glaucoma secondary to eye inflammation, bilateral, stage unspecified

H40.43X1 Glaucoma secondary to eye inflammation, bilateral, mild stage

H40.43X2 Glaucoma secondary to eye inflammation, bilateral, moderate stage

H40.43X3 Glaucoma secondary to eye inflammation, bilateral, severe stage

H40.43X4 Glaucoma secondary to eye inflammation, bilateral, indeterminate stage

H40.50X0 Glaucoma secondary to other eye disorders, unspecified eye, stage unspecified

H40.50X1 Glaucoma secondary to other eye disorders, unspecified eye, mild stage

H40.50X2 Glaucoma secondary to other eye disorders, unspecified eye, moderate stage

H40.50X3 Glaucoma secondary to other eye disorders, unspecified eye, severe stage

H40.50X4 Glaucoma secondary to other eye disorders, unspecified eye, indeterminate stage

H40.51X0 Glaucoma secondary to other eye disorders, right eye, stage unspecified

H40.51X1 Glaucoma secondary to other eye disorders, right eye, mild stage

H40.51X2 Glaucoma secondary to other eye disorders, right eye, moderate stage

H40.51X3 Glaucoma secondary to other eye disorders, right eye, severe stage

H40.51X4 Glaucoma secondary to other eye disorders, right eye, indeterminate stage

H40.52X0 Glaucoma secondary to other eye disorders, left eye, stage unspecified

H40.52X1 Glaucoma secondary to other eye disorders, left eye, mild stage

H40.52X2 Glaucoma secondary to other eye disorders, left eye, moderate stage

H40.52X3 Glaucoma secondary to other eye disorders, left eye, severe stage

H40.52X4 Glaucoma secondary to other eye disorders, left eye, indeterminate stage

H40.53X0 Glaucoma secondary to other eye disorders, bilateral, stage unspecified

H40.53X1 Glaucoma secondary to other eye disorders, bilateral, mild stage

H40.53X2 Glaucoma secondary to other eye disorders, bilateral, moderate stage

H40.53X3 Glaucoma secondary to other eye disorders, bilateral, severe stage

H40.53X4 Glaucoma secondary to other eye disorders, bilateral, indeterminate stage

H40.60X0 Glaucoma secondary to drugs, unspecified eye, stage unspecified

H40.60X1 Glaucoma secondary to drugs, unspecified eye, mild stage

H40.60X2 Glaucoma secondary to drugs, unspecified eye, moderate stage

H40.60X3 Glaucoma secondary to drugs, unspecified eye, severe stage

H40.60X4 Glaucoma secondary to drugs, unspecified eye, indeterminate stage

H40.61X0 Glaucoma secondary to drugs, right eye, stage unspecified

H40.61X1 Glaucoma secondary to drugs, right eye, mild stage

H40.61X2 Glaucoma secondary to drugs, right eye, moderate stage

H40.61X3 Glaucoma secondary to drugs, right eye, severe stage

H40.61X4 Glaucoma secondary to drugs, right eye, indeterminate stage

H40.62X0 Glaucoma secondary to drugs, left eye, stage unspecified

H40.62X1 Glaucoma secondary to drugs, left eye, mild stage

H40.62X2 Glaucoma secondary to drugs, left eye, moderate stage

H40.62X3 Glaucoma secondary to drugs, left eye, severe stage

H40.62X4 Glaucoma secondary to drugs, left eye, indeterminate stage

H40.63X0 Glaucoma secondary to drugs, bilateral, stage unspecified

H40.63X1 Glaucoma secondary to drugs, bilateral, mild stage

H40.63X2 Glaucoma secondary to drugs, bilateral, moderate stage

H40.63X3 Glaucoma secondary to drugs, bilateral, severe stage

H40.63X4 Glaucoma secondary to drugs, bilateral, indeterminate stage

H40.811 Glaucoma with increased episcleral venous pressure, right eye

H40.812 Glaucoma with increased episcleral venous pressure, left eye

H40.813 Glaucoma with increased episcleral venous pressure, bilateral

H40.819 Glaucoma with increased episcleral venous pressure, unspecified eye

H40.821 Hypersecretion glaucoma, right eye

H40.822 Hypersecretion glaucoma, left eye

H40.823 Hypersecretion glaucoma, bilateral

H40.829 Hypersecretion glaucoma, unspecified eye

H40.831 Aqueous misdirection, right eye

H40.832 Aqueous misdirection, left eye

H40.833 Aqueous misdirection, bilateral

H40.839 Aqueous misdirection, unspecified eye

H40.89 Other specified glaucoma

H40.9 Unspecified glaucoma

H42 Glaucoma in diseases classified elsewhere

H44.511 Absolute glaucoma, right eye

H44.512 Absolute glaucoma, left eye

H44.513 Absolute glaucoma, bilateral

H44.519 Absolute glaucoma, unspecified eye

P15.3 Birth injury to eye

Q15.0 Congenital glaucoma

IMPLANTATION OF AB INTERNO STENTS ARE MEDICALLY NECESSARY WHEN REPORTED WITH ANY OF THE FOLLOWING DIAGNOSIS CODES FOR CATARACT AND ANY OF THE FOLLOWING DIAGNOSIS CODES USED TO REPRESENT MILD-TO-MODERATE OPEN-ANGLE GLAUCOMA:

THE FOLLOWING DIAGNOSIS CODES ARE USED TO REPRESENT CATARACTS:

E08.36 Diabetes mellitus due to underlying condition with diabetic cataract

E09.36 Drug or chemical induced diabetes mellitus with diabetic cataract

E10.36 Type 1 diabetes mellitus with diabetic cataract

E11.36 Type 2 diabetes mellitus with diabetic cataract

E13.36 Other specified diabetes mellitus with diabetic cataract

H25.011 Cortical age-related cataract, right eye

H25.012 Cortical age-related cataract, left eye

H25.013 Cortical age-related cataract, bilateral

H25.019 Cortical age-related cataract, unspecified eye

H25.031 Anterior subcapsular polar age-related cataract, right eye

H25.032 Anterior subcapsular polar age-related cataract, left eye

H25.033 Anterior subcapsular polar age-related cataract, bilateral

H25.039 Anterior subcapsular polar age-related cataract, unspecified eye

H25.041 Posterior subcapsular polar age-related cataract, right eye

H25.042 Posterior subcapsular polar age-related cataract, left eye

H25.043 Posterior subcapsular polar age-related cataract, bilateral

H25.049 Posterior subcapsular polar age-related cataract, unspecified eye

H25.091 Other age-related incipient cataract, right eye

H25.092 Other age-related incipient cataract, left eye

H25.093 Other age-related incipient cataract, bilateral

H25.099 Other age-related incipient cataract, unspecified eye

H25.10 Age-related nuclear cataract, unspecified eye

H25.11 Age-related nuclear cataract, right eye

H25.12 Age-related nuclear cataract, left eye

H25.13 Age-related nuclear cataract, bilateral

H25.20 Age-related cataract, morgagnian type, unspecified eye

H25.21 Age-related cataract, morgagnian type, right eye

H25.22 Age-related cataract, morgagnian type, left eye

H25.23 Age-related cataract, morgagnian type, bilateral

H25.811 Combined forms of age-related cataract, right eye

H25.812 Combined forms of age-related cataract, left eye

H25.813 Combined forms of age-related cataract, bilateral

H25.819 Combined forms of age-related cataract, unspecified eye

H25.89 Other age-related cataract

H25.9 Unspecified age-related cataract

H26.001 Unspecified infantile and juvenile cataract, right eye

H26.002 Unspecified infantile and juvenile cataract, left eye

H26.003 Unspecified infantile and juvenile cataract, bilateral

H26.009 Unspecified infantile and juvenile cataract, unspecified eye

H26.011 Infantile and juvenile cortical, lamellar, or zonular cataract, right eye

H26.012 Infantile and juvenile cortical, lamellar, or zonular cataract, left eye

H26.013 Infantile and juvenile cortical, lamellar, or zonular cataract, bilateral

H26.019 Infantile and juvenile cortical, lamellar, or zonular cataract, unspecified eye

H26.031 Infantile and juvenile nuclear cataract, right eye

H26.032 Infantile and juvenile nuclear cataract, left eye

H26.033 Infantile and juvenile nuclear cataract, bilateral

H26.039 Infantile and juvenile nuclear cataract, unspecified eye

H26.041 Anterior subcapsular polar infantile and juvenile cataract, right eye

H26.042 Anterior subcapsular polar infantile and juvenile cataract, left eye

H26.043 Anterior subcapsular polar infantile and juvenile cataract, bilateral

H26.049 Anterior subcapsular polar infantile and juvenile cataract, unspecified eye

H26.051 Posterior subcapsular polar infantile and juvenile cataract, right eye

H26.052 Posterior subcapsular polar infantile and juvenile cataract, left eye

H26.053 Posterior subcapsular polar infantile and juvenile cataract, bilateral

H26.059 Posterior subcapsular polar infantile and juvenile cataract, unspecified eye

H26.061 Combined forms of infantile and juvenile cataract, right eye

H26.062 Combined forms of infantile and juvenile cataract, left eye

H26.063 Combined forms of infantile and juvenile cataract, bilateral

H26.069 Combined forms of infantile and juvenile cataract, unspecified eye

H26.09 Other infantile and juvenile cataract

H26.101 Unspecified traumatic cataract, right eye

H26.102 Unspecified traumatic cataract, left eye

H26.103 Unspecified traumatic cataract, bilateral

H26.109 Unspecified traumatic cataract, unspecified eye

H26.111 Localized traumatic opacities, right eye

H26.112 Localized traumatic opacities, left eye

H26.113 Localized traumatic opacities, bilateral

H26.119 Localized traumatic opacities, unspecified eye

H26.121 Partially resolved traumatic cataract, right eye

H26.122 Partially resolved traumatic cataract, left eye

H26.123 Partially resolved traumatic cataract, bilateral

H26.129 Partially resolved traumatic cataract, unspecified eye

H26.131 Total traumatic cataract, right eye

H26.132 Total traumatic cataract, left eye

H26.133 Total traumatic cataract, bilateral

H26.139 Total traumatic cataract, unspecified eye

H26.20 Unspecified complicated cataract

H26.211 Cataract with neovascularization, right eye

H26.212 Cataract with neovascularization, left eye

H26.213 Cataract with neovascularization, bilateral

H26.219 Cataract with neovascularization, unspecified eye

H26.221 Cataract secondary to ocular disorders (degenerative) (inflammatory), right eye

H26.222 Cataract secondary to ocular disorders (degenerative) (inflammatory), left eye

H26.223 Cataract secondary to ocular disorders (degenerative) (inflammatory), bilateral

H26.229 Cataract secondary to ocular disorders (degenerative) (inflammatory), unspecified eye

H26.231 Glaucomatous flecks (subcapsular), right eye

H26.232 Glaucomatous flecks (subcapsular), left eye

H26.233 Glaucomatous flecks (subcapsular), bilateral

H26.239 Glaucomatous flecks (subcapsular), unspecified eye

H26.30 Drug-induced cataract, unspecified eye

H26.31 Drug-induced cataract, right eye

H26.32 Drug-induced cataract, left eye

H26.33 Drug-induced cataract, bilateral

H26.40 Unspecified secondary cataract

H26.411 Soemmering's ring, right eye

H26.412 Soemmering's ring, left eye

H26.413 Soemmering's ring, bilateral

H26.419 Soemmering's ring, unspecified eye

H26.491 Other secondary cataract, right eye

H26.492 Other secondary cataract, left eye

H26.493 Other secondary cataract, bilateral

H26.499 Other secondary cataract, unspecified eye

H26.8 Other specified cataract

H26.9 Unspecified cataract

H28 Cataract in diseases classified elsewhere

Q12.0 Congenital cataract

THE FOLLOWING DIAGNOSIS CODES ARE USED TO REPRESENT MILD-TO-MODERATE OPEN-ANGLE GLAUCOMA:

H40.10X1 Unspecified open-angle glaucoma, mild stage

H40.10X2 Unspecified open-angle glaucoma, moderate stage

H40.1111 Primary open-angle glaucoma, right eye, mild stage

H40.1112 Primary open-angle glaucoma, right eye, moderate stage

H40.1121 Primary open-angle glaucoma, left eye, mild stage

H40.1122 Primary open-angle glaucoma, left eye, moderate stage

H40.1131 Primary open-angle glaucoma, bilateral, mild stage

H40.1132 Primary open-angle glaucoma, bilateral, moderate stage

H40.1191 Primary open-angle glaucoma, unspecified eye, mild stage

H40.1192 Primary open-angle glaucoma, unspecified eye, moderate stage

H40.1211 Low-tension glaucoma, right eye, mild stage

H40.1212 Low-tension glaucoma, right eye, moderate stage

H40.1221 Low-tension glaucoma, left eye, mild stage

H40.1222 Low-tension glaucoma, left eye, moderate stage

H40.1231 Low-tension glaucoma, bilateral, mild stage

H40.1232 Low-tension glaucoma, bilateral, moderate stage

H40.1291 Low-tension glaucoma, unspecified eye, mild stage

H40.1292 Low-tension glaucoma, unspecified eye, moderate stage

H40.1311 Pigmentary glaucoma, right eye, mild stage

H40.1312 Pigmentary glaucoma, right eye, moderate stage

H40.1321 Pigmentary glaucoma, left eye, mild stage

H40.1322 Pigmentary glaucoma, left eye, moderate stage

H40.1331 Pigmentary glaucoma, bilateral, mild stage

H40.1332 Pigmentary glaucoma, bilateral, moderate stage

H40.1391 Pigmentary glaucoma, unspecified eye, mild stage

H40.1392 Pigmentary glaucoma, unspecified eye, moderate stage

H40.1411 Capsular glaucoma with pseudoexfoliation of lens, right eye, mild stage

H40.1412 Capsular glaucoma with pseudoexfoliation of lens, right eye, moderate stage

H40.1421 Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stage

H40.1422 Capsular glaucoma with pseudoexfoliation of lens, left eye, moderate stage

H40.1431 Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stage

H40.1432 Capsular glaucoma with pseudoexfoliation of lens, bilateral, moderate stage

H40.1491 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, mild stage

H40.1492 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, moderate stage

H40.151 Residual stage of open-angle glaucoma, right eye

H40.152 Residual stage of open-angle glaucoma, left eye

H40.153 Residual stage of open-angle glaucoma, bilateral

H40.159 Residual stage of open-angle glaucoma, unspecified eye

CANALOPLASTY IS MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES:

H40.1110 Primary open-angle glaucoma, right eye, stage unspecified

H40.1111 Primary open-angle glaucoma, right eye, mild stage

H40.1112 Primary open-angle glaucoma, right eye, moderate stage

H40.1113 Primary open-angle glaucoma, right eye, severe stage

H40.1114 Primary open-angle glaucoma, right eye, indeterminate stage

H40.1120 Primary open-angle glaucoma, left eye, stage unspecified

H40.1121 Primary open-angle glaucoma, left eye, mild stage

H40.1122 Primary open-angle glaucoma, left eye, moderate stage

H40.1123 Primary open-angle glaucoma, left eye, severe stage

H40.1124 Primary open-angle glaucoma, left eye, indeterminate stage

H40.1130 Primary open-angle glaucoma, bilateral, stage unspecified

H40.1131 Primary open-angle glaucoma, bilateral, mild stage

H40.1132 Primary open-angle glaucoma, bilateral, moderate stage

H40.1133 Primary open-angle glaucoma, bilateral, severe stage

H40.1134 Primary open-angle glaucoma, bilateral, indeterminate stage

H40.1190 Primary open-angle glaucoma, unspecified eye, stage unspecified

H40.1191 Primary open-angle glaucoma, unspecified eye, mild stage

H40.1192 Primary open-angle glaucoma, unspecified eye, moderate stage

H40.1193 Primary open-angle glaucoma, unspecified eye, severe stage

H40.1194 Primary open-angle glaucoma, unspecified eye, indeterminate stage

Version Effective Date: 07/08/2019
Version Issued Date: 07/08/2019
Version Reissued Date: N/A

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