Glaucoma secondary to eye trauma, right eye, stage unsp

This code signifies elevated intraocular pressure and optic nerve damage in the right eye, directly resulting from a previous injury to the eye. The specific stage or severity of the glaucoma is not documented or determined at the time of coding. This condition can lead to progressive vision loss if left untreated.

Use this code when documentation clearly links glaucoma in the right eye to a history of eye trauma, and the stage of glaucoma is not specified. This applies to cases where the trauma is the direct cause of the secondary glaucoma. Supporting documentation would include a history of eye injury, elevated IOP readings, optic nerve damage, and a physician's diagnosis explicitly stating "glaucoma secondary to trauma, right eye, stage unspecified."

• Ensure the documentation explicitly states the glaucoma is "secondary to eye trauma" and specifies the "right eye."
• If the stage of glaucoma (e.g., mild, moderate, severe, indeterminate) is documented, a more specific code from the H40.31 category should be used.
• Code the underlying eye trauma (e.g., S05.xx) as an additional diagnosis, if applicable and still relevant to the current encounter.