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Angle-Closure Glaucoma F028

Document
Last amended 
26 June 2015
Current RMA Instruments:
Reasonable Hypothesis SOP
25 of 2012
Balance of Probabilities SOP
26 fo 2012
Changes from Previous Instruments:

SOP Bulletin 157

ICD Coding:
  • ICD-9-CM Codes: 365.2, 365.59, 365.61
  • ICD-10-AM Codes: H40.2, H40.5
Is specific diagnostic evidence required to apply the SOP?Yes.

Establish that the veteran has angle-closure glaucoma and not open-angle glaucoma (see comments)

Are there sub-factors that require specific information? – Yes. 

See comments, below.

Additional diagnoses covered by SOP
  • primary angle-closure glaucoma
Conditions that may be covered by SOP (further information required)
  • neovascular glaucoma – this may be open-angle or angle-closure in type.
Conditions not covered by SOP
  • borderline glaucoma, ICD code 365.0
  • chronic simple glaucoma, ICD code 365.11
  • congenital glaucoma, ICD code 365.4
  • ghost cell glaucoma, ICD code 365.10
  • phacolytic glaucoma, ICD code 365.51
  • pigmentary glaucoma, ICD code 365.13
  • open-angle glaucoma, ICD code 365.1, 365.3, 365.51, 365.52, 365.62-365.65 (see comments), 365.81 or 365.82.
Unconfirmed diagnosis

If, after applying the above information, you are unable to confirm the diagnosis, you should then:

  1. seek medical officer advice about further investigation, or;
  2. generate a diagnostic report, or;
  3. re-encode the condition, if appropriate.

The following investigations may be useful in establishing the diagnosis.

  • A report from an ophthalmologist.
Comments

There are separate RMA SOPs for angle-closure glaucoma and open-angle glaucoma.

A diagnostic questionnaire is available to investigate the diagnosis.  This should be sent to the treating ophthalmologist.

Of all non-congenital glaucoma cases:

  • Approximately 85% are primary open-angle glaucoma.
  • Approximately 10% are primary angle-closure glaucoma.
  • Approximately 5% are secondary glaucoma, either open-angle or angle-closure.

Open angle glaucomas generally present with chronic, painless, progressive loss of vision.  Whereas, angle closure glaucomas generally present as a painful red eye.

A condition covered by an ICD code in the range of 365.62-365.65 may be either an open-angle type glaucoma or an angle-closure type glaucoma. To determine such conditions you need to know which of these types is present and apply the appropriate SOP.  Obtain this information before proceeding further with the claim.

This SOP also contains a factor that applies only to acute angle-closure glaucoma.  To apply this factor you will therefore need information from an ophthalmologist that establishes this specific diagnosis.  It may be possible to finalise the claim without this information, particularly if the claim can succeed using another factor.