Valid for Submission
H40.1113 is a billable diagnosis code used to specify a medical diagnosis of primary open-angle glaucoma, right eye, severe stage. The code H40.1113 is valid during the fiscal year 2022 from October 01, 2021 through September 30, 2022 for the submission of HIPAA-covered transactions.
The code H40.1113 is linked to some Quality Measures as part of Medicare's Quality Payment Program (QPP). When this code is used as part of a patient's medical record the following Quality Measures might apply: Primary Open-angle Glaucoma (poag): Optic Nerve Evaluation , Primary Open-angle Glaucoma (poag): Reduction Of Intraocular Pressure (iop) By 15% Or Documentation Of A Plan Of Care.
Diagnostic Related Groups - MS-DRG Mapping
|MS-DRG||MS-DRG Title||MCD||Relative Weight|
|124||OTHER DISORDERS OF THE EYE WITH MCC||02||1.3988|
|125||OTHER DISORDERS OF THE EYE WITHOUT MCC||02||0.8354|
The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.
H401113 replaces the following previously assigned ICD-10 code(s):
Convert H40.1113 to ICD-9 Code
Quality Payment Program Measures
When code H40.1113 is part of the patient's diagnoses the following Quality Measures apply and affect reimbursement. The objective of Medicare's Quality Measures is to improve patient care by making it more: effective, safe, efficient, patient-centered and equitable.
|Quality Measure||Description||Quality Domain||Measure Type||High Priority||Submission Methods|
|Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation||Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months.||Effective Clinical Care||Process||NO||Claims, Electronichealthrecord, Registry|
|Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care||Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 15% from the pre-intervention level) OR if the most recent IOP was not reduced by at least 15% from the pre-intervention level, a plan of care was documented within the 12 month performance period.||Communication and Care Coordination||Outcome||YES||Claims, Registry|
Information for Patients
Glaucoma is a group of diseases that can damage the eye's optic nerve. It is a leading cause of blindness in the United States. It usually happens when the fluid pressure inside the eyes slowly rises, damaging the optic nerve. Often there are no symptoms at first. Without treatment, people with glaucoma will slowly lose their peripheral, or side vision. They seem to be looking through a tunnel. Over time, straight-ahead vision may decrease until no vision remains.
A comprehensive eye exam can tell if you have glaucoma. People at risk should get eye exams at least every two years. They include
- African Americans over age 40
- People over age 60, especially Mexican Americans
- People with a family history of glaucoma
There is no cure, but glaucoma can usually be controlled. Early treatment can help protect your eyes against vision loss. Treatments usually include prescription eyedrops and/or surgery.
NIH: National Eye Institute
[Learn More in MedlinePlus]