H40.243
BillableResidual stage of angle-closure glaucoma, bilateral
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
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
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)