2027 ICD-10-CM Diagnosis Code H40.1312Pigmentary glaucoma, right eye, moderate stage
H40.1312 is a billable ICD-10-CM diagnosis code for pigmentary glaucoma, right eye, moderate stage. The 7th character 2 means moderate stage. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 124 through 125. The code is not accepted as a principal diagnosis by the Medicare Code Editor. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Glaucoma.
H40.1312 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 243 for payment year 2027.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for H40.1312.
Medicare Risk Adjustment (HCC)Billing
H40.1312 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model, but it maps to payment categories in the other CMS models shown below.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to H40.1312: its own notes plus those printed at H40.13, H40, and Chapter 7. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury (trauma) of eye and orbit (S05.-)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
- syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)
Notes
General instructions on how these codes are used.
- Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition
7th Character
Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.
- One of the following 7th characters is to be assigned to each code in subcategory H40.13 to designate the stage of glaucoma
- 0stage unspecified
- 1mild stage
- 2moderate stage this code
- 3severe stage
- 4indeterminate stage
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name H40.1312, its category, or a range that includes it.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Glaucoma, Open-Angle
glaucoma in which the angle of the anterior chamber is open and the trabecular meshwork does not encroach on the base of the iris.
Patient EducationClinical
Glaucoma
Glaucoma is a group of diseases that can damage the optic nerve of one, or both, of your eyes. This can result in vision loss. There are different types of glaucoma, but the most common type is open-angle glaucoma. Other less common types include angle-closure glaucoma, and congenital glaucoma.
The full article covers:
- What is glaucoma?
- What causes glaucoma?
- What are the symptoms of glaucoma?
- How is glaucoma diagnosed?
- What are the treatments for glaucoma?
- Can glaucoma be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert H40.1312 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About H40.1312Overview
What is the ICD-10 code for pigmentary glaucoma, right eye, moderate stage?
The ICD-10-CM code for pigmentary glaucoma, right eye, moderate stage is H40.1312 (sometimes written as H401312). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is H40.1312 (Pigmentary glaucoma, right eye) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report pigmentary glaucoma, right eye, moderate stage on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character 2 in H40.1312 mean?
The final character 2 means moderate stage, in this case for the pigmentary glaucoma. It comes from the 7th character list in the CMS Tabular List for this category.
What MS-DRG does H40.1312 group to?
On inpatient claims, pigmentary glaucoma, right eye, moderate stage maps to MS-DRG 125, 124, with relative weights from 0.7699 to 1.2470 depending on complications. Higher weights mean higher Medicare reimbursement.
Can H40.1312 be a principal diagnosis?
No. The Medicare Code Editor rejects this code as a principal diagnosis because pigmentary glaucoma, right eye, moderate stage describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.
Does H40.1312 risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage: H40.1312 maps to no category in the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 243 (Glaucoma, Open-Angle or Moderate/Severe Stage).
