Staging and Laterality Rules in Glaucoma Billing
Glaucoma ICD-10-CM codes carry laterality in the 6th character and stage in the 7th character. A claim missing either one can deny, and a test billed with an unspecified stage invites a medical necessity review. The example below shows how one diagnosis is built.
| Part | Example | Meaning |
|---|---|---|
| Category | H40.11 | Primary open-angle glaucoma |
| 6th character | H40.113 | Bilateral |
| 7th character | H40.1132 | Moderate stage |
Glaucoma suspects use their own codes (H40.0-), which support fewer tests. Our coders check that the stage in the claim matches the stage in the chart.
Testing Frequency Limits for Glaucoma Patients
Glaucoma testing is where most glaucoma denials happen. Each test has its own limits.
- Optic nerve OCT (92133), which cannot be billed with 92134 on the same day
- Visual fields (92081, 92082, 92083), billed by the extent of the test
- Gonioscopy (92020), often bundled with exam codes by some payers
- Pachymetry (76514), which Medicare usually covers once per lifetime
- Serial tonometry (92100) on a separate day from the exam
We track each patient's last billed date for every test, so a test performed early is caught before it denies. When the chart documents progression that justifies an early test, we attach that finding to the claim.
Glaucoma Laser and MIGS Coding
Glaucoma procedures range from in-office lasers to combined cataract and stent surgery. The table lists the codes we bill most.
| Procedure | Code | Billing note |
|---|---|---|
| Selective laser trabeculoplasty | 65855 | Per eye, global period applies |
| Laser peripheral iridotomy | 66761 | Per eye, per session |
| Trabecular bypass stent with routine cataract | 66991 | One unit per eye per day |
| Trabecular bypass stent with complex cataract | 66989 | One unit per eye per day |
| Standalone trabecular stent | 0671T | Not billed with 66989 or 66991 |
| Goniotomy | 65820 | Check payer policy for newer techniques |
| Trabeculectomy | 66170, 66172 | 90-day global |
| Aqueous shunt | 66180 | 90-day global, implant supply rules |
Medicare contractors publish MIGS billing articles that list the diagnoses supporting each code. We check those lists before surgery is scheduled.
Glaucoma Shared Care Billing Across the USA
Across the USA, many glaucoma patients are monitored by optometrists and referred to ophthalmologists for lasers and surgery. Both practices bill testing, and both depend on the same frequency limits. When we serve both sides, test dates stay consistent. See optometry billing services for the optometry side.
What Do Glaucoma Billing Reports Show?
Our monthly report for glaucoma practices shows testing volume by code, test denial rates by payer and the share of tests billed with an unspecified stage. That last number shows documentation gaps quickly. Combined MIGS cases are reported beside cataract surgery billing results. A free billing audit shows your current test denial rate.