What is ICD-10 code H40.243?

H40.243 is the ICD-10-CM diagnosis code for Residual stage of angle-closure glaucoma, bilateral. A chronic eye condition affecting both eyes where angle-closure glaucoma has reached its residual stage with permanent structural changes in both eyes following previous acute episodes. H40.243 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H40.243 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. H40.243 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. H40.243 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for H40.243?

H40.243 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards H40.243 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

What should coders know when reporting H40.243?

Confirm bilateral involvement is documented; this code requires evidence of residual stage glaucoma in both eyes Document any differences in severity or vision loss between the two eyes for clinical clarity

H40.243 ICD-10 Code: Residual stage

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupH40.243Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Glaucoma (H40-H42)

H40.243

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Residual stage of angle-closure glaucoma, bilateral

A chronic eye condition affecting both eyes where angle-closure glaucoma has reached its residual stage with permanent structural changes in both eyes following previous acute episodes.

Buddy Insight

Residual stage angle-closure glaucoma indicates permanent structural damage remaining after an acute or chronic angle-closure episode has resolved.

CMS-HCC V28

Not risk-adjusted for this model/period.

RAF 0

CMS-HCC V24

Not risk-adjusted for this model/period.

RAF 0

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Not risk-adjusted for this model/period.

RAF 0

RXHCC

Mapped

HCC 244

Glaucoma, Other

RAF 0.0

Code Trumping

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Code Book Path

Official

H40.2Primary angle-closure glaucoma

H40.24Residual stage of angle-closure glaucoma

H40.243Residual stage of angle-closure glaucoma, bilateral

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for H40.243 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for H40.243 in this effective period.

Related Child Codes

Official

H40.241Residual stage of angle-closure glaucoma, right eye

H40.242Residual stage of angle-closure glaucoma, left eye

H40.249Residual stage of angle-closure glaucoma, unspecified eye

Includes

Official

ICD-10-CM does not list Includes notes for H40.243 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for H40.243 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for H40.243 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for H40.243 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for H40.243 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documented history of prior angle-closure glaucoma episode (acute, subacute, or chronic)

Laterality clearly specified as bilateral in the clinical note

Gonioscopy or anterior segment imaging confirming residual angle changes

Current intraocular pressure (IOP) measurement

MEAT Support

HCC Buddy guidance

Documented history of prior angle-closure glaucoma episode (acute, subacute, or chronic)

Laterality clearly specified as bilateral in the clinical note

Gonioscopy or anterior segment imaging confirming residual angle changes

Current intraocular pressure (IOP) measurement

Audit Caution

HCC Buddy guidance

Coding residual stage when the angle-closure episode is still active — residual stage means the acute/chronic phase has fully resolved

Failing to document laterality, which is required for accurate code assignment at the 6th character level

Using unspecified eye (H40.249) when laterality is documented in the record — always code to the highest specificity

Not distinguishing between residual damage from angle closure versus new or concurrent open-angle glaucoma

Common Mistakes

HCC Buddy guidance

H40.211-H40.219 — Acute angle-closure glaucoma (use when the acute episode is currently active, not resolved)

H40.221-H40.229 — Chronic angle-closure glaucoma (use when angle closure is ongoing, not yet in residual stage)

H40.231-H40.239 — Intermittent angle-closure glaucoma (use for episodic angle closure that recurs)

H40.10-H40.14 — Open-angle glaucoma (different mechanism; angle is open, not closed)

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 H40.243 an HCC code?

No. H40.243 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.

HCC Category Mapping

RxHCCHCC 244, Glaucoma, Other

0.000

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 H40.243

For H40.243to 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 H40.243 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

H40.243 is the ICD-10-CM diagnosis code for residual stage of angle-closure glaucoma, bilateral. A chronic eye condition affecting both eyes where angle-closure glaucoma has reached its residual stage with permanent structural changes in both eyes following previous acute episodes. H40.243 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).

H40.243 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.

Maps to RxHCC 244 (Glaucoma, Other) with a RAF weight of 0.000 in the prescription drug model. This code does not map to any CMS-HCC under v28 or v24 models. While the RxHCC mapping carries no incremental RAF weight, it is relevant for pharmacy risk adjustment and may influence prescription drug plan cost predictions. No hierarchies apply within the CMS-HCC models for this code.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H40.243 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Confirm bilateral involvement is documented; this code requires evidence of residual stage glaucoma in both eyes
•Document any differences in severity or vision loss between the two eyes for clinical clarity

Clinical Significance

Residual stage angle-closure glaucoma indicates permanent structural damage remaining after an acute or chronic angle-closure episode has resolved. This diagnosis captures the long-term sequelae of angle closure, which may include peripheral anterior synechiae, optic nerve damage, and irreversible vision loss. Accurate coding ensures ongoing monitoring and treatment needs are reflected in the patient's risk profile.

Documentation Requirements

✓Documented history of prior angle-closure glaucoma episode (acute, subacute, or chronic)
✓Laterality clearly specified as bilateral in the clinical note
✓Gonioscopy or anterior segment imaging confirming residual angle changes
✓Current intraocular pressure (IOP) measurement
✓Description of residual structural damage (e.g., peripheral anterior synechiae, optic disc changes, visual field deficits)
✓Current treatment plan including any ongoing medications or monitoring schedule

Commonly Confused Codes

•H40.211-H40.219: Acute angle-closure glaucoma (use when the acute episode is currently active, not resolved)
•H40.221-H40.229: Chronic angle-closure glaucoma (use when angle closure is ongoing, not yet in residual stage)
•H40.231-H40.239: Intermittent angle-closure glaucoma (use for episodic angle closure that recurs)
•H40.10-H40.14: Open-angle glaucoma (different mechanism; angle is open, not closed)
•H42: Glaucoma in diseases classified elsewhere (use when glaucoma is secondary to a systemic condition)