H40.012 ICD-10-CM Code: Open angle with borderline findings, low risk, left eye

H40.012 is the ICD-10-CM diagnosis code for open angle with borderline findings, low risk, left eye. This code describes a patient with open-angle glaucoma in the left eye that shows early warning signs but is currently at low risk for vision loss. The eye pressure and optic nerve appearance are borderline, meaning they are not yet in the clearly abnormal range but warrant monitoring. H40.012 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).

H40.012 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

This code requires laterality specification (left eye) and risk stratification (low risk), so ensure documentation clearly indicates the eye affected and the ophthalmologist's risk assessment.