Crystal's MCW Coder Hub🧬 ICD-10-CM H40.62X2 — Glaucoma Secondary to Drugs, Left Eye, Moderate Stage
Billable Code Confirmed — 7 Characters Complete
ICD-10 CM H40.62X2 is a valid, billable 7-character ICD-10-CM code for FY2025. Structure:
H40(glaucoma) +.6(secondary to drugs) +2(left eye) +X(structural placeholder) +2(moderate stage). Complete and current.
Non-Billable Parent Codes — Do Not Submit
- ❌
H40.62— 5-character header — non-billable- ❌
H40.6— 4-character header — non-billable
🚨 MANDATORY ADDITIONAL CODE — T-Code Required
Same instruction as the entire H40.6x family: “Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5).”
Cross-Reference — Full Clinical Content
🔍 Code Description
ICD-10 CM H40.62X2 classifies glaucoma secondary to drug therapy, left eye, at the moderate stage — established drug-induced glaucomatous optic neuropathy in the left eye with a Humphrey Visual Field 24-2 mean deviation (MD) between -6 dB and -12 dB, outside the central 5° of fixation. The underlying mechanism, drug exposures, IOP dynamics, and T-code framework are identical to the right-eye counterpart H40.61X2 — the sole coding distinction is the 6th character: “2” for left eye vs. “1” for right eye and the corresponding -LT procedure modifier on all unilateral CPT codes.
Moderate stage is the clinical inflection point in drug-induced glaucoma management — the stage where physicians must weigh medical escalation against surgical intervention, where SLT eligibility peaks, and where the MIGS conversation becomes urgent. Central vision remains intact, but the field loss is significant enough that progression to H40.62X3 (severe) carries a real risk of functional disability.
🔑 The Only Thing That Changed — Laterality
Right Eye → Left Eye: The One-Character Shift
| Element | Right Eye | Left Eye |
|---|---|---|
| Code | H40.61X2 | H40.62X2 |
| 6th character | 1 = Right | 2 = Left |
| CPT modifier | -RT | -LT |
| Tonometry documentation | IOP OD | IOP OS |
| HVF laterality | 24-2 OD | 24-2 OS |
| OCT laterality | RNFL OD | RNFL OS |
| Stage criteria | Identical | Identical |
| T-code | T38.0X5X | T38.0X5X |
LT Modifier Is Non-Negotiable for Left Eye CPT Codes
Every unilateral CPT code billed for left-eye glaucoma services requires the -LT modifier. Omitting it on a claim for a unilateral procedure defaults to “unspecified side” in most payer systems and will generate a mismatch with H40.62X2 (which explicitly specifies left eye). Apply LT to:
🌳 Left Eye H40.62X — Full Stage Family
H40.62 Left Eye — Glaucoma Secondary to Drugs ❌ Non-billable
│ [T-code required at all stages]
│
├── H40.62X0 Stage unspecified ⚠️ Documentation gap — query
├── H40.62X1 Mild stage MD > -6 dB
├── H40.62X2 MODERATE stage MD -6 to -12 dB ← THIS CODE ✅
├── H40.62X3 Severe stage MD < -12 dB or within 5° of fixation
└── H40.62X4 Indeterminate stage Cannot stage — document reason
📊 Asymmetric Bilateral Glaucoma — The Most Common Real-World Scenario
Drug-induced glaucoma (particularly steroid-induced) frequently presents asymmetrically — one eye at a different stage than the other. This is where laterality-specific coding earns its keep in the record.
Common Asymmetric Stage Combinations
| Right Eye | Left Eye | Codes to Assign |
|---|---|---|
| Mild — H40.61X1 | Moderate — H40.62X2 ← | H40.61X1 + H40.62X2 + T-code |
| Moderate — H40.61X2 | Moderate — H40.62X2 | Consider H40.63X2 (bilateral moderate) if documented bilaterally |
| Moderate — H40.61X2 | Moderate — H40.62X2 | If stages truly equal → H40.63X2 preferred |
| Severe — H40.61X3 | Moderate — H40.62X2 ← | H40.61X3 + H40.62X2 + T-code |
| Indeterminate — H40.61X4 | Moderate — H40.62X2 ← | H40.61X4 + H40.62X2 + T-code |
Bilateral Code vs. Two Laterality Codes — The Decision Rule
Use H40.63X2 (bilateral, moderate) ONLY when BOTH eyes are at the same moderate stage AND the physician documents bilateral disease of equal stage. Use H40.61X2 + H40.62X2 when the eyes are at different stages — bilateral code is not appropriate for asymmetric staging. Use H40.62X2 alone when only the left eye has glaucoma documented and the right eye is normal or has a different condition.
🛠️ CPT Template — Left Eye Moderate Stage
Template: Established Glaucoma Monitoring Visit — Left Eye Moderate
| Code | Modifier | Description | Notes |
|---|---|---|---|
| 92014 | — | Comprehensive exam, established | Full bilateral exam — no modifier |
| 92083 | -LT | HVF 24-2 SITA Standard, left eye | Staging field — documents MD -6 to -12 dB |
| 92133 | -LT | OCT optic nerve/RNFL, left eye | RNFL thinning — structural staging |
| H40.62X2 | Primary Dx | Left eye, moderate | |
| T38.0X5D | Required additional | Adverse effect — subsequent encounter |
Bilateral HVF and OCT — Modifier Logic
When both eyes are tested on the same date of service:
- 92083 can be billed once for a bilateral visual field test — no modifier when both eyes tested together under one CPT unit
- 92133 billed with -50 modifier (bilateral) OR as two line items with -RT and -LT — verify payer preference; some payers prefer -50, others prefer two lines
- When only the left eye is tested: 92083-LT or 92133-LT as single units
💊 Coding Scenario
Scenario — Asymmetric Bilateral SIG, Right Mild / Left Moderate
Clinical Vignette: A 61-year-old female with steroid-induced glaucoma secondary to chronic inhaled budesonide presents for 4-month follow-up. IOP OD: 18 mmHg on latanoprost. IOP OS: 22 mmHg on latanoprost + timolol — target not met. HVF 24-2: OD MD -3.8 dB (mild, stable). OS MD -8.1 dB (moderate — progressed from -6.4 dB at last visit). OCT RNFL OS: progressive superior thinning. Physician: “Steroid-induced glaucoma — right eye mild, stable. Left eye moderate — progression on OCT and VF. Left eye not at target IOP. Adding brimonidine OS. Discussing SLT OS at next visit.”
ICD-10-CM:
- H40.61X1 — Glaucoma secondary to drugs, right eye, mild (OD MD -3.8 dB, stable)
- H40.62X2 — Glaucoma secondary to drugs, left eye, moderate (OS MD -8.1 dB, progressed)
- T38.0X5D — Adverse effect of glucocorticoids, subsequent encounter (one T-code covers both eyes — same drug)
CPT:
- 92014 — Comprehensive exam, established
- 92083 — HVF bilateral (both eyes tested — no modifier)
- 92133-LT — OCT RNFL, left eye (progression monitoring on problem eye)
One T-Code Covers Both Eyes When Same Drug Is the Cause
When bilateral drug-induced glaucoma is caused by the same corticosteroid exposure, a single T38.0X5D covers both laterality codes — you do not need to list it twice. The T-code identifies the causative drug for the encounter; the two laterality-specific H40.6x codes identify each eye’s disease and stage independently.
🔗 Related Codes — Left Eye H40.62X Family
| Code | Description |
|---|---|
| H40.62X0 | Left eye, stage unspecified ⚠️ — query |
| H40.62X1 | Left eye, mild stage |
| H40.62X2 | Left eye, moderate stage ← This Code |
| H40.62X3 | Left eye, severe stage |
| H40.62X4 | Left eye, indeterminate stage |
| H40.63X2 | Bilateral, moderate stage — use when both eyes equal stage |
| H40.61X2 | Right eye, moderate — full clinical reference |
| T38.0X5D | Adverse effect glucocorticoids, subsequent ← mandatory |
⚠️ Coding Pitfalls and Tips
| Pitfall or Tip | |
|---|---|
| ❌ | Never submit H40.62X2 without T38.0X5x T-code — mandatory [ |
| ❌ | Never use H40.62X2 when both eyes are the same moderate stage — use bilateral H40.63X2 instead, or confirm whether asymmetric coding is appropriate |
| ❌ | Never omit the LT modifier on unilateral left-eye CPT codes — modifier must match laterality documented in diagnosis code |
| ❌ | Never submit H40.62 (5 characters) as billable — non-billable header |
| ✅ | 6th character “2” = left eye — mirror of “1” for right eye — applies identically across all H40.6x codes |
| ✅ | One T-code covers both eyes when bilateral glaucoma caused by same drug |
| ✅ | Asymmetric stages → two laterality codes — one for each eye at its confirmed stage |
| ✅ | Equal bilateral stage → H40.63X2 — bilateral code is preferred when both eyes confirmed at same stage |
| ✅ | All staging criteria, T-code rules, and CPT guidance in H40.61X2 apply identically — just flip the laterality and modifier |
| ✅ | CMS LCD A56916 confirms H40.62X2 as covered Dx for 92133 OCT |
📚 Sources
1. AAPC. ICD-10-CM Code H40.61 — Glaucoma secondary to drugs, right eye. T-code use additional code instruction confirmed; full H40.6x family structure including left-eye codes. [web:207]
2. Coding Billing Solutions. “Glaucoma ICD-10 Codes.” H40.62X2 left eye moderate confirmed in H40.6x family structure. [web:199]
3. CMS LCD Article A56916 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI). Full H40.6x family — including left-eye codes — confirmed as covered diagnoses for CPT 92133. [web:54]
4. Ophthalmology Management. “ICD-10 Comes to Glaucoma.” Glaucoma staging criteria — HPA mean deviation thresholds; asymmetric bilateral staging rules. [web:244]
5. See H40.61X2 for complete citation list covering pathophysiology, T-code adverse effect framework, staging criteria detail, SLT/MIGS guidance, and CPT billing templates.