Q15.0

Here is a detailed guide note for Q15.0, formatted as clean text for your reference.

Q15.0: Congenital Glaucoma

Description

• Definition: A form of glaucoma present at birth or developing in early childhood, often caused by abnormal development of the eye’s drainage system (trabecular meshwork) before birth.
• Includes:
  • Buphthalmos (enlargement of the eye).
  • Glaucoma of the newborn.
  • Hydrophthalmos.
  • Keratoglobus, congenital, with glaucoma.
  • Macrocornea with glaucoma.
  • Megalocornea with glaucoma.
• Excludes:
  • Congenital nystagmus (H55.01).
  • Ocular albinism (E70.31-).
  • Optic nerve hypoplasia (H47.03-).

Body area

• Eye (globe/anterior segment/aqueous outflow structures); congenital condition (Chapter 17 codes are not for use on maternal records).​​

Includes / Excludes

• Includes (per ICD-10-CM tabular under Q15.0): Axenfeld’s anomaly, buphthalmos, glaucoma of childhood, glaucoma of newborn, hydrophthalmos, and related congenital corneal size/shape anomalies “with glaucoma” (e.g., macrocornea/megalocornea with glaucoma).​[​

• Excludes1 (category Q15 “Other congenital malformations of eye”): Congenital nystagmus (H55.01), ocular albinism (E70.319), optic nerve hypoplasia (H47.03-), retinitis pigmentosa (H35.52).​​

• Excludes2: Not shown for Q15.0 in the available excerpt.

Risk Adjustment (HCC) Status

• HCC Weight: No.
• Clinical Note: Unlike specific stages of adult open-angle glaucoma which may map to risk adjustment categories in some models, congenital malformations like Q15.0 generally do not carry an HCC weight.

Common Associated CPT Codes

1. Diagnostic Exams (Crucial for Infants)

• 92018: Examination under general anesthesia (EUA), complete.
• 92019: Examination under general anesthesia (EUA), limited.
  • Context: Because infants and young children cannot cooperate for a standard slit-lamp exam or tonometry in the office, an EUA is frequently required to measure intraocular pressure (IOP) and corneal diameter.

2. Diagnostic Imaging

• 76513: Ophthalmic Ultrasound, diagnostic; anterior segment (UBM).
  • Usage: Used to visualize the anterior chamber angle structures, ciliary body, and iris configuration which may be malformed.
• 92132: Scanning Computerized Ophthalmic Diagnostic Imaging, Anterior Segment (AS-OCT).
  • Usage: Non-invasive imaging to assess the angle and corneal thickness.

3. Surgical Intervention

• 65820: Goniotomy (surgical opening of the trabecular meshwork).
• 65850: Trabeculotomy (creating a communication between the anterior chamber and Schlemm’s canal).
  • Note: These are the primary surgeries for congenital glaucoma, distinct from the trabeculectomy (66170) often done in adults.

Compliance & Coding Tips

• No Laterality: Unlike adult glaucoma codes (H40.-) which require specifying Right, Left, or Bilateral, Q15.0 does not have laterality sub-codes. You report the same code regardless of whether one or both eyes are affected.
• Inclusions Matter: If the documentation mentions “Buphthalmos” or “Hydrophthalmos,” Q15.0 is the correct code to report, as these are specific manifestations of the congenital pressure elevation.
• Sequencing: If the glaucoma is part of a larger syndrome (e.g., Sturge-Weber or Lowe Syndrome), code the syndrome first, followed by Q15.0.

Common modifiers (CPT)

Modifier	Meaning (high-level)	Common eye-care use
-25	Significant, separately identifiable E/M	E/M with same-day procedure/testing
-RT	Right side	Eye laterality
-LT	Left side	Eye laterality
-50	Bilateral procedure	When a procedure is done both eyes (payer rules apply)
-59	Distinct procedural service	When appropriate to indicate a distinct service (watch NCCI edits)

Common CPTs used with this diagnosis (examples)

• 92004 / 92014 or 99202-99205 / 99212-99215 (exam/E/M depending on documentation and payer rules).​

• 92020 (gonioscopy—key for angle assessment in glaucoma workups).​

• 92083 (extended visual field testing).​

• 92133 (OCT optic nerve/retinal nerve fiber layer imaging used in glaucoma evaluation/monitoring; coverage varies by payer/MAC).

Example coding

Example: Pediatric ophthalmologist documents “primary congenital glaucoma” (infant/child) → assign Q15.0 Congenital glaucoma.