H40.249
BillableResidual stage of angle-closure glaucoma, unspecified eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H40.249 an HCC code?
No. H40.249 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 H40.249
For H40.249to 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 H40.249 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
H40.249 is the ICD-10-CM diagnosis code for residual stage of angle-closure glaucoma, unspecified eye. This code describes the final stage of angle-closure glaucoma after the acute attack has resolved, where the eye has sustained permanent damage from the previous episode of elevated eye pressure. The condition affects an unspecified eye (meaning the documentation doesn't specify left, right, or bilateral). H40.249 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).
H40.249 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 H40.249 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always verify the laterality in the medical record and use the appropriate 5th character (1=right eye, 2=left eye, 3=bilateral, 9=unspecified) rather than defaulting to unspecified when documentation is available
- •Ensure the diagnosis clearly documents 'residual stage' rather than acute or intermittent angle-closure glaucoma, as this indicates chronic sequelae from a previous acute episode
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 unspecified eye 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)