| H40.5 # # # # # | Glaucoma secondary to other eye disorders Ghost cell glaucoma ICE syndrome with glaucoma Mobile lens with glaucoma Neovascular glaucoma [NVG] Phacomorphic glaucoma |
| Use additional code, if desired, to identify cause. | |
| H40.6 # | Glaucoma secondary to drugs Steroid-induced glaucoma |
2018/2019 ICD-10-CM Diagnosis Code H40.0. Glaucoma suspect. 2016 2017 2018 2019 Non-Billable/Non-Specific Code. H40.0 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.
Ghost cell glaucoma is a secondary open-angle glaucoma caused by degenerated red blood cells (ghost cells) blocking the trabecular meshwork. Glaucoma associated with vascular disorders Following a vitreous hemorrhage episode, blood breakdown products may accumulate in the trabecular meshwork.
The diagnosis of ghost cell glaucoma is usually clinical. The history and paracentesis with phase-contrast microscopy of the aspirate would confirm this diagnosis. For spontaneous hemorrhages, complete blood count with coagulation profile and sickle cell prep in African American patients are warranted.
If you look at 365.63 Glaucoma associated with vascular disorder in the GEM cross walk it takes you to H40.89. This would be the biggest argument that the H40.89 would be the best code to use.
Ghost cell glaucoma is a secondary open-angle glaucoma caused by degenerated red blood cells (ghost cells) obstructing the trabecular meshwork.
If RBCs become swollen in dilute urine to the point that the cell membrane ruptures, the cell loses its hemoglobin so that only the membrane and free hemoglobin remain. These empty membranes are known as "ghost" cells.
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A ghost cell is an enlarged eosinophilic epithelial cell with eosinophilic cytoplasm but without a nucleus. The ghost cells indicate coagulative necrosis where there is cell death but retainment of cellular architecture. In histologic sections ghost cells are those which appear as shadow cells. They are dead cells.
Ghost cell is a swollen/enlarged epithelial cell with eosnophilic cytoplasm, but without a nucleus. In routine H and E staining these cells give a shadowy appearance. Hence these cells are also called as shadow cells or translucent cells.
H40. 9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM H40.
unspecified open-angle glaucoma H40. 10- unspecified primary angle-closure glaucoma H40. 20-
Although 304 ICD-10 codes contain the word glaucoma, only one exists for glaucoma suspect (H40. 0).
Clinically, patients present with intraocular pressure (IOP) spikes (as high as 60 to 70 mmHg) and a history of vitreous hemorrhage resulting from trauma, surgery, or preexisting retinal disease 1-3 months prior to presentation. The IOP may be markedly elevated, causing corneal edema. The anterior chamber is filled with small, circulating, tan colored cells. If fresh red blood cells exist, two or more different layers of cells are seen, with the lighter khaki-colored layer of ghost cells appearing on top of a heavier, red blood cell layer, imparting a candy-striped appearance. The cellular reaction appears out of proportion to the aqeous flare. The conjunctiva tends not be inflamed unless the IOP is markedly elevated or there is a history of previous surgery. Gonioscopy reveals either a normal appearing open angle; an open angle covered by a fine layer of khaki-colored cells, which have slightly to moderately discolored the trabecular meshwork; or a heavy layer filling the angle, generally inferiorly, with cells composing an early pseudohypopyon. The vitreous has the appearance of an old hemorrhage, with characteristic khaki coloration of RBCs and clumps of extracellular pigmentation from degenerated hemoglobin.
Hemolytic Glaucoma is a type of secondary glaucoma where red blood cell debris and macrophages block the trabecular meshwork after a vitreous hemorrhage. In ghost cell glaucoma, little to no red blood cell debris and few to no macrophages are found in the trabecular meshwork. Neovascular glaucoma is differentiated from ghost cell glaucoma by ...
Ghost cell glaucoma is a clinical diagnosis. Diagnostic findings include presence of heme in the vitreous, ghost cells in the anterior chamber, delayed onset of increased intraocular pressure, an open angle on gonioscopy with possible presence of ghost cells layering over the trabecular meshwork inferiorly due to gravity , and often a disrupted anterior hyaloid face. Historically, the diagnosis of ghost cell glaucoma was made by phase-contrast microscopy* of anterior chamber (AC) aspirate, paraffin embedding after centrifugation of AC aspirate, or staining of the sample with 1 % methyl violet. Heinz bodies, spherical erythrocytes with denaturized hemoglobin granules bound to the internal surface of the cell membrane, are observed with H&E staining.
A constellation of histopathologic findings may develop in the vitreous following vitreous hemorrhage. After 3-10 days, red blood cell (RBC) clots undergo fibrinolysis and red blood cells may diffuse throughout the vitreous cavity. At this time, breakdown of red blood cells also occurs. The hemoglobin that remains within the cell denatures and forms clumps called Heinz bodies, which adhere to the inner surface of the plasma membrane. The extracellular hemoglobin also becomes denatured and clumped, often forming small to large accumulations that tend to adhere to vitreous strands. The adherence to and the entrapment within vitreous strands prevents these extracellular clumps of hemoglobin from moving freely and from passing into the anterior chamber. Loss of hemoglobin from the red blood cells produces ghost cells and hemoglobin spherules. During the conversion to the ghost cell form, intracellular hemoglobin is lost, presumably through leaky membranes, into the extracellular vitreous spaces. Ghost cells appear as small, spherical, khaki-colored cells and do not adhere to each other or to the vitreous strands and are free to move anteriorly. They gain access to the anterior chamber through a disrupted anterior hyaloid face, which can occur from previous surgery (pars plana vitrectomy, cataract extraction, or capsulotomy), trauma or spontaneous disruption. Ghost cells are generally 4 to 7 micrometers in size and less pliable than normal RBCs. As a result of their loss of pliability, ghost cells remain longer in the anterior chamber because their rigidity makes it difficult for them to escape through the trabecular meshwork. This causes obstruction of the trabecular meshwork and secondary glaucoma. The cells develop within 1-3 months of a vitreous hemorrhage. It is important to note that the presence of ghost cells does not necessarily lead to development of ghost cell glaucoma.
Following a vitreous hemorrhage episode, blood breakdown products may accumulate in the trabecular meshwork. Hemolyzed erythrocytes may obstruct aqueous outflow and lead to a secondary open-angle glaucoma known as ghost cell glaucoma.
During the conversion to the ghost cell form, intracellular hemoglobin is lost, presumably through leaky membranes, into the extracellular vitreous spaces. Ghost cells appear as small, spherical, khaki-colored cells and do not adhere to each other or to the vitreous strands and are free to move anteriorly.
As a result of their loss of pliability, ghost cells remain longer in the anterior chamber because their rigidity makes it difficult for them to escape through the trabecular meshwork. This causes obstruction of the trabecular meshwork and secondary glaucoma. The cells develop within 1-3 months of a vitreous hemorrhage.