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H47.231

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Short Description

Glaucomatous optic atrophy of the right eye, representing irreversible optic nerve fiber loss secondary to chronic or advanced glaucoma.

Full Clinical Description

H47.231 identifies optic nerve atrophy caused by glaucomatous damage, specifically affecting the right eye. This condition reflects permanent structural loss of retinal ganglion cell axons, typically resulting from chronically elevated intraocular pressure (IOP) or impaired optic nerve perfusion.

Glaucomatous optic atrophy is characterized by:

  • Progressive optic disc cupping
  • Neuroretinal rim thinning
  • Corresponding visual field defects
  • Reduced retinal nerve fiber layer (RNFL) thickness on OCT

Unlike primary optic atrophy, glaucomatous atrophy is secondary, meaning the underlying glaucoma diagnosis must be documented and supported elsewhere in the record. This code should not be used in isolation without evidence of glaucoma‑related pathology.

Clinical permanence is implied; improvement is not expected once atrophy is established.
[Derived from longitudinal optic neuropathy models and disc morphology studies]

Key Documentation Requirements

To support H47.231, documentation should clearly include:

  • Confirmed glaucoma diagnosis (type and severity)
  • Laterality explicitly stated (right eye)
  • Objective findings such as:
    • Optic disc cupping ratio
    • OCT RNFL thinning
    • Visual field loss consistent with glaucoma
  • Statement linking optic atrophy to glaucoma, not another etiology

Avoid vague terms like “optic nerve pallor” without causal attribution.

HCC / Risk Adjustment

  • HCC Status: ❌ Not an HCC
  • Risk Adjustment Impact: None
  • RAF Contribution: 0.000

Although vision‑threatening, optic atrophy codes do not map to CMS‑HCC models.
[Cross‑referenced against hierarchical condition group exclusions]

Commonly Associated ICD‑10‑CM Codes

CodeDescription
H40.11X*Primary open‑angle glaucoma
H40.22X*Chronic angle‑closure glaucoma
H40.89Other specified glaucoma
H47.232Glaucomatous optic atrophy, left eye
H47.233Glaucomatous optic atrophy, bilateral
H47.239Glaucomatous optic atrophy, unspecified eye

Glaucoma code selection should reflect type + stage when available.

Sample CPT Codes Often Seen With This Diagnosis

CPTDescription
92133OCT optic nerve imaging
92083Visual field examination
92250Fundus photography
92014Comprehensive ophthalmologic exam
99213-99215E/M (non‑ophthalmology settings)

CPT selection depends on provider specialty, setting, and documentation depth.

Clinical & Coding Pearls

  • Laterality is mandatory — unspecified eye codes increase denial risk.
  • Do not confuse glaucomatous optic atrophy with:
    • Ischemic optic neuropathy
    • Optic neuritis
    • Hereditary optic atrophy
  • Optic atrophy implies irreversible damage — avoid using for early glaucoma without structural loss.
  • Ensure glaucoma severity supports the presence of atrophy.

Common Coding Pitfalls

  • Coding optic atrophy without a documented glaucoma diagnosis
  • Using H47.2 (unspecified optic atrophy) when etiology is known
  • Failing to document laterality
  • Treating optic nerve cupping alone as optic atrophy

Audit Defense Notes

  • Maintain imaging reports (OCT, VF) in the chart
  • Ensure provider explicitly links optic atrophy to glaucoma
  • Avoid copy‑forward language that omits laterality or cause

[Aligned with specialty‑specific documentation integrity reviews and payer audit trends]

  • [[H40 - Glaucoma]]
  • [[H47 - Disorders of optic nerve]]
  • [[OCT Documentation Standards]]
  • [[Visual Field Interpretation]]

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