H40.1322 ICD-10-CM Code: Pigmentary glaucoma, left eye, moderate stage
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Glaucoma (H40-H42)
H40.1322
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePigmentary glaucoma, left eye, moderate stage
Pigmentary glaucoma, left eye, moderate stage
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 243
RAF 0.196
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H40.1322 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H40.1322 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H40.1322 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H40.1322 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H40.1322 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H40.1322 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H40.1322 in this effective period.
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H40.1322 an HCC code?
H40.1322 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Glaucoma under the Part D RxHCC model.
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work H40.1322 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for H40.1322
For H40.1322to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed H40.1322 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
H40.1322 is the ICD-10-CM diagnosis code for pigmentary glaucoma, left eye, moderate stage. H40.1322 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).
H40.1322 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.
H40.1322 is a billable ICD-10-CM code that can be reported on claims but does not currently contribute to a Medicare Advantage member's RAF score under any CMS risk adjustment model (V28, V24, ESRD, or RxHCC). Coders reviewing H40.1322 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H40.1322 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.