H40.812
BillableGlaucoma with increased episcleral venous pressure, left eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H40.812 an HCC code?
No. H40.812 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 H40.812
For H40.812to 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 H40.812 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
H40.812 is the ICD-10-CM diagnosis code for glaucoma with increased episcleral venous pressure, left eye. A type of glaucoma in the left eye caused by elevated pressure in the small blood vessels on the eye's surface, leading to increased intraocular pressure and potential vision loss. H40.812 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).
H40.812 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. No mapping exists under CMS-HCC v28, v24, or ESRD models. The RxHCC classification captures the pharmacy cost implications of ongoing glaucoma treatment. No hierarchies apply for this code.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H40.812 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify left eye involvement is clearly documented in the clinical record
- •Link to any systemic or orbital conditions that may be causing the episcleral venous pressure elevation
Clinical Significance
Glaucoma with increased episcleral venous pressure is a secondary glaucoma caused by elevated venous pressure in the episcleral veins, leading to impaired aqueous humor outflow and increased intraocular pressure. This can result from conditions such as carotid-cavernous fistula, Sturge-Weber syndrome, or superior vena cava syndrome. Identifying the underlying cause is critical for appropriate management and risk stratification.
Documentation Requirements
- ✓Laterality clearly specified as left eye
- ✓Documented elevated episcleral venous pressure or clinical evidence thereof (dilated episcleral veins on examination)
- ✓Intraocular pressure measurement
- ✓Identification of the underlying cause of increased episcleral venous pressure (e.g., orbital or vascular condition)
- ✓Optic nerve assessment including cup-to-disc ratio
- ✓Visual field testing results if available
- ✓Current treatment plan and monitoring schedule
Commonly Confused Codes
- •H40.10-H40.14 — Open-angle glaucoma, unspecified or by stage (does not specify the secondary etiology)
- •H40.50-H40.53 — Secondary glaucoma due to other eye diseases (different underlying mechanism)
- •H40.60-H40.63 — Secondary glaucoma due to drugs (medication-induced, not vascular)
- •H40.89 — Other specified glaucoma (less specific; use H40.81x when episcleral venous pressure is the identified cause)