What is ICD-10 code H40.819?

H40.819 is the ICD-10-CM diagnosis code for Glaucoma with increased episcleral venous pressure, unspecified eye. A type of glaucoma caused by elevated pressure in the small blood vessels on the eye's surface when the specific eye affected is not documented or is unclear. H40.819 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H40.819 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. H40.819 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. H40.819 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 H40.819?

H40.819 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 community model rewards H40.819 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. It does, however, map under the Part D RxHCC model (Glaucoma, Other), which affects the ESRD and/or Part D (RxHCC) risk scores. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

What should coders know when reporting H40.819?

Use only when laterality cannot be determined from the medical record; query the provider if possible for eye-specific documentation This is a less specific code; attempt to obtain laterality information for more accurate coding

2026 ICD-10-CM H40.819: Glaucoma with increased episcleral

ICD-10-CM Code View

HCC Buddy Code Card

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Code lookupH40.819Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

H40.819

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

Glaucoma with increased episcleral venous pressure, unspecified eye

A type of glaucoma caused by elevated pressure in the small blood vessels on the eye's surface when the specific eye affected is not documented or is unclear.

Buddy Insight

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

Mapped

HCC 244

Glaucoma, Other

RAF 0.067

Code Book Path

Official

H40.8Other glaucoma

H40.81Glaucoma with increased episcleral venous pressure

H40.819Glaucoma with increased episcleral venous pressure, unspecified eye

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for H40.819 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for H40.819 in this effective period.

Related Child Codes

Official

H40.811Glaucoma with increased episcleral venous pressure, right eye

H40.812Glaucoma with increased episcleral venous pressure, left eye

H40.813Glaucoma with increased episcleral venous pressure, bilateral

Includes

Official

ICD-10-CM does not list Includes notes for H40.819 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for H40.819 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for H40.819 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for H40.819 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for H40.819 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Laterality clearly specified as unspecified 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)

MEAT Support

HCC Buddy guidance

Laterality clearly specified as unspecified 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)

Audit Caution

HCC Buddy guidance

Coding as primary open-angle glaucoma when the underlying cause is elevated episcleral venous pressure — this is a secondary glaucoma

Failing to code the underlying vascular or orbital condition that causes the increased episcleral venous pressure

Using unspecified glaucoma (H40.9) when the specific type is documented

Omitting laterality when it is clearly documented in the clinical record

Common Mistakes

HCC Buddy guidance

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)

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is H40.819 an HCC code?

H40.819 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Glaucoma, Other under the Part D RxHCC model.

Code: H40.819
Description: Glaucoma with increased episcleral venous pressure, unspecified eye
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

RxHCCHCC 244, Glaucoma, Other

0.067

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work H40.819 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for H40.819

For H40.819 to 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 H40.819 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

H40.819 is the ICD-10-CM diagnosis code for glaucoma with increased episcleral venous pressure, unspecified eye. A type of glaucoma caused by elevated pressure in the small blood vessels on the eye's surface when the specific eye affected is not documented or is unclear. H40.819 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).

H40.819 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.

This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing H40.819 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H40.819 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use only when laterality cannot be determined from the medical record; query the provider if possible for eye-specific documentation
•This is a less specific code; attempt to obtain laterality information for more accurate coding

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 unspecified 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)