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ICD-10 Guide
ICD-10 CodesChapter 7: Diseases of the eye and adnexaH42

H42

Billable

Glaucoma in diseases classified elsewhere

Chapter 7:Diseases of the eye and adnexa

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 H42 is a billable code used to indicate a diagnosis of glaucoma in diseases classified elsewhere.

Key Diagnostic Point:

The ICD-10 code H42 is designated for glaucoma that occurs as a result of other diseases classified elsewhere. This category encompasses various forms of glaucoma that are secondary to underlying conditions such as diabetes, hypertension, or other systemic diseases. Clinicians must be aware that while the primary disease may be the focus of treatment, the presence of glaucoma necessitates careful monitoring and management to prevent vision loss. The clinical significance of this category lies in its ability to highlight the need for comprehensive care that addresses both the primary disease and its ocular complications.

  • In practice, the use of H42 codes is crucial for accurate documentation and billing, as it indicates that the glaucoma is not a standalone condition but rather a complication of another health issue. This distinction is important for ensuring appropriate reimbursement and for tracking the prevalence of glaucoma in patients with other systemic diseases. Proper coding can also facilitate better patient management strategies and outcomes, as it encourages healthcare providers to consider the broader implications of a patient's health status on their ocular health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Comorbidities
  • Variability in presentation
  • Need for multidisciplinary management

Audit Risk Factors

  • Inadequate documentation of primary disease
  • Failure to specify type of glaucoma
  • Misuse of codes leading to denials

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Endocrinology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical impact of the H42 code category is significant, as it highlights the importance of recognizing and managing glaucoma in patients with other systemic diseases. This awareness can lead to improved patient outcomes through timely interventions and comprehensive care strategies. From an administrative perspective, accurate coding of H42 can influence quality measures and population health data, as it provides insights into the prevalence of glaucoma in patients with comorbid conditions.
Healthcare trends indicate a growing emphasis on integrated care models, where the management of systemic diseases and their ocular complications are addressed simultaneously. This approach not only enhances patient care but also aligns with value-based care initiatives aimed at improving overall health outcomes. By utilizing H42 codes appropriately, healthcare providers can contribute to a more holistic understanding of patient health and the interconnections between systemic and ocular conditions.

ICD-9 vs ICD-10

The clinical impact of the H42 code category is significant, as it highlights the importance of recognizing and managing glaucoma in patients with other systemic diseases. This awareness can lead to improved patient outcomes through timely interventions and comprehensive care strategies. From an administrative perspective, accurate coding of H42 can influence quality measures and population health data, as it provides insights into the prevalence of glaucoma in patients with comorbid conditions. Healthcare trends indicate a growing emphasis on integrated care models, where the management of systemic diseases and their ocular complications are addressed simultaneously. This approach not only enhances patient care but also aligns with value-based care initiatives aimed at improving overall health outcomes. By utilizing H42 codes appropriately, healthcare providers can contribute to a more holistic understanding of patient health and the interconnections between systemic and ocular conditions.

Reimbursement & Billing Impact

reimbursement policies may vary based on the complexity of the case and the documentation provided.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for H42

Coding & Billing References

  • •
    Official ICD-10 Guidelines for H42

Frequently Asked Questions

What conditions are included in H42?

H42 includes glaucoma that is secondary to systemic diseases such as diabetes mellitus, hypertension, and other conditions that may affect intraocular pressure.

When should I use H42 codes?

H42 codes should be used when documenting glaucoma that arises as a complication of another disease, ensuring that the primary condition is also coded appropriately.

What documentation is required for H42?

Documentation must include the primary diagnosis leading to glaucoma, details of the glaucoma type, and any relevant clinical findings that support the diagnosis.