H40.159
BillableResidual stage of open-angle glaucoma, unspecified eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H40.159 an HCC code?
No. H40.159 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for H40.159
For H40.159to 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 H40.159 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
H40.159 is the ICD-10-CM diagnosis code for residual stage of open-angle glaucoma, unspecified eye. The final stage of open-angle glaucoma in an eye where the specific side (right or left) is not documented or is unclear. H40.159 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).
H40.159 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.
In the RxHCC model, H40.159 maps to RxHCC 243 (Glaucoma) with a RAF weight of 0.0. No V28, V24, or ESRD HCC mappings exist. The HCC mapping is identical to laterality-specific codes, so risk adjustment value is unchanged. However, unspecified laterality may face increased audit scrutiny in risk adjustment data validation.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H40.159 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the eye laterality cannot be determined from the medical record
- •Query the provider if possible to determine which eye is affected for more specific coding
Clinical Significance
Residual stage of open-angle glaucoma, unspecified eye is used when residual glaucoma damage is documented but the laterality is not specified. This code should be avoided when possible since ophthalmic examinations routinely document laterality. It represents a documentation quality issue that should be addressed through provider query or record review.
Documentation Requirements
- ✓Documentation of residual stage open-angle glaucoma without laterality specification
- ✓Evidence of prior glaucoma with current arrested disease state
- ✓Documentation of residual optic nerve damage or visual field loss
- ✓Query to the examining ophthalmologist for laterality clarification
- ✓Treatment and monitoring plan
Commonly Confused Codes
- •H40.151-H40.153 — Laterality-specific residual stage open-angle glaucoma: always preferred when laterality documented
- •H40.10X0 — Unspecified open-angle glaucoma, unspecified eye: does not specify residual stage
- •H40.9 — Unspecified glaucoma: even less specific, does not capture open-angle type or stage
- •H40.239 — Intermittent angle-closure glaucoma, unspecified eye: different type of glaucoma