Skip to main content

H49.889 ICD-10-CM Code: Other paralytic strabismus, unspecified eye

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
4 Excludes2

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 123 — NEUROLOGICAL EYE DISORDERS (MDC 02)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for H49.889 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on H49.889 itself; “inherited from” names the category or block whose note applies here.

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Coder workflow for H49.889

MedCoder structured workflow — derived from this code’s own official record

Before you code H49.889

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, H49.889 may be the appropriate code. Check the record for detail that supports a more specific sibling. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    ReviewH49.881, H49.882, H49.883

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: unspecified). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

    ReviewH49.881 · right, H49.882 · left

    Guide: Laterality coding →

Choose the right path

  1. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — H49.889 is appropriate when the documentation goes no further.

    ReviewH49.881, H49.882, H49.883

  2. Is the side documented?
    Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
    No → Use the unspecified-side code only when the record states no side; a query is the alternative.

    ReviewH49.881 · right, H49.882 · left

Consider H49.889. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Laterality
Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes2 — not part of H49.889(4 notes)

    Coding workflow: The conditions named in this note are not included in H49.889. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareH52.51, H51.2, G23.1, H55

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the specific siblings in this subcategory and what each requires the record to state.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

ReviewH49.881, H49.882, H49.883

Documentation: The record documents the condition on one side only.

Coding question: Which code in this family applies?

Path: Select the sibling code for the documented side.

Reason: Laterality is assigned from the documented side; the unspecified-side code is for records that state no side (Guidelines I.B.13).

ReviewH49.881 · right, H49.882 · left

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse H49.889 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of H49.889 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • H49.881— Laterality relationship (Review)

    Same condition; these differ only in which side is documented.

    The same condition on the other side; the documented side decides, and a bilateral code, where one exists, replaces the pair when both sides are documented.

    What moves you there: A documented right side moves the case to H49.881.

    Full comparison: H49.889 vs H49.881 →

  • H49.882— Laterality relationship (Review)

    Same condition; these differ only in which side is documented.

    The same condition on the other side; the documented side decides, and a bilateral code, where one exists, replaces the pair when both sides are documented.

    What moves you there: A documented left side moves the case to H49.882.

    Full comparison: H49.889 vs H49.882 →

  • H52.51— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of internal ophthalmoplegia adds H52.51; it is not part of this code and both may be reported when both are documented.

    Full comparison: H49.889 vs H52.51 →

  • H51.2— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of internuclear ophthalmoplegia adds H51.2; it is not part of this code and both may be reported when both are documented.

    Full comparison: H49.889 vs H51.2 →

  • G23.1— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of progressive supranuclear ophthalmoplegia adds G23.1; it is not part of this code and both may be reported when both are documented.

    Full comparison: H49.889 vs G23.1 →

  • H55— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of nystagmus and other irregular eye movements adds H55; it is not part of this code and both may be reported when both are documented.

    Full comparison: H49.889 vs H55 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Code Overview

Other paralytic strabismus, unspecified eye is a billable ICD-10-CM diagnosis code (H49.889).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name H49.889 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes2 note: G52 — Disorders of other cranial nerves (via H49.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 1 MS-DRG: DRG 123 (MDC 02).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):EYE006 — Neuro-ophthalmology (default); EYE007 — Strabismus.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same condition, opposite side

Same category and title, differing only in which side of the body is affected.

H49.881 — Other paralytic strabismus, right eye (right)Compare H49.889 vs H49.881 →, H49.882 — Other paralytic strabismus, left eye (left)Compare H49.889 vs H49.882 →

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Neuro-ophthalmology, Strabismus).

H49.41 — Progressive external ophthalmoplegia, right eye, H49.42 — Progressive external ophthalmoplegia, left eye, H49.43 — Progressive external ophthalmoplegia, bilateral, H49.811 — Kearns-Sayre syndrome, right eye, H49.812 — Kearns-Sayre syndrome, left eye, H49.813 — Kearns-Sayre syndrome, bilateral, H49.819 — Kearns-Sayre syndrome, unspecified eye, H49.881 — Other paralytic strabismus, right eye, H49.882 — Other paralytic strabismus, left eye, H49.883 — Other paralytic strabismus, bilateral, H49.9 — Unspecified paralytic strabismus, H50.00 — Unspecified esotropia, H50.011 — Monocular esotropia, right eye, H50.012 — Monocular esotropia, left eye, H50.021 — Monocular esotropia with A pattern, right eye, H50.022 — Monocular esotropia with A pattern, left eye, H50.031 — Monocular esotropia with V pattern, right eye, H50.032 — Monocular esotropia with V pattern, left eye, H50.041 — Monocular esotropia with other noncomitancies, right eye, H50.042 — Monocular esotropia with other noncomitancies, left eye, +183 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Strabismus”, “Parinaud's”, “Ophthalmoplegia”; these codes share that main term but sit in a different category of the Tabular List.

E05.00 — Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm (exophthalmic), E05.01 — Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm (exophthalmic, with thyroid storm), G23.1 — Progressive supranuclear ophthalmoplegia [Steele-Richardson-Olszewski] (supranuclear, progressive), G61.0 — Guillain-Barre syndrome (ataxia-areflexia), H10.89 — Other conjunctivitis (conjunctivitis), H50.00 — Unspecified esotropia (convergent concomitant), H50.01 — Monocular esotropia (convergent concomitant, monocular), H50.02 — Monocular esotropia with A pattern (convergent concomitant, monocular, with, A pattern), H50.03 — Monocular esotropia with V pattern (convergent concomitant, monocular, with, V pattern), H50.04 — Monocular esotropia with other noncomitancies (convergent concomitant, monocular, with, specified nonconcomitances NEC), H50.05 — Alternating esotropia (convergent concomitant, alternating), H50.06 — Alternating esotropia with A pattern (convergent concomitant, alternating, with, A pattern), H50.07 — Alternating esotropia with V pattern (convergent concomitant, alternating, with, V pattern), H50.08 — Alternating esotropia with other noncomitancies (convergent concomitant, alternating, with, specified nonconcomitances NEC), H50.10 — Unspecified exotropia (divergent concomitant), H50.11 — Monocular exotropia (divergent concomitant, monocular), H50.12 — Monocular exotropia with A pattern (divergent concomitant, monocular, with, A pattern), H50.13 — Monocular exotropia with V pattern (divergent concomitant, monocular, with, V pattern), H50.14 — Monocular exotropia with other noncomitancies (divergent concomitant, monocular, with, specified noncomitances NEC), H50.15 — Alternating exotropia (divergent concomitant, alternating), +27 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Blood Glucose Test, Thyroid Stimulating Hormone (TSH)

Contextual Map

Every relationship of H49.889 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run H49.889 with this related code in Claim Check

Hierarchy

Referenced by Excludes2 notes

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 02 — Diseases and Disorders of the Eye[MDC crossing]: “Diseases and Disorders of the Eye — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,200 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Nearest codes (37)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "H49.889 — Other paralytic strabismus, unspecified eye." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/h49.889-other-paralytic-strabismus-unspecified-eye

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Other paralytic strabismus, unspecified eye

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to H49.889 in its code family, with their registry titles.

View all codes in the H49 family