H51.11 ICD-10-CM Code: Convergence insufficiency

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for H51.11 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on H51.11 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for H51.11

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

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).

Official instructions as workflow

• Excludes2 — not part of H51.11(1 note)

  Coding workflow: The conditions named in this note are not included in H51.11. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareH55

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

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.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Disorder (of), binocular, movement, convergence, insufficiency
• Exophoria, convergence, insufficiency
• Insufficiency, insufficient, convergence

Don’t confuse H51.11 with…

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

The codes most likely to be picked instead of H51.11 — 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.

• 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: H51.11 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.

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

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 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 2 MS-DRGs: DRG 124 (MDC 02), DRG 125 (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):EYE012 — Other specified eye disorders (default).

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 clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Other specified eye disorders).

H44.759 — Retained (nonmagnetic) (old) foreign body in vitreous body, unspecified eye, H44.791 — Retained (old) intraocular foreign body, nonmagnetic, in other or multiple sites, right eye, H44.792 — Retained (old) intraocular foreign body, nonmagnetic, in other or multiple sites, left eye, H44.793 — Retained (old) intraocular foreign body, nonmagnetic, in other or multiple sites, bilateral, H44.799 — Retained (old) intraocular foreign body, nonmagnetic, in other or multiple sites, unspecified eye, H44.811 — Hemophthalmos, right eye, H44.812 — Hemophthalmos, left eye, H44.813 — Hemophthalmos, bilateral, H44.819 — Hemophthalmos, unspecified eye, H51.0 — Palsy (spasm) of conjugate gaze, H51.12 — Convergence excess, H55.00 — Unspecified nystagmus, H55.01 — Congenital nystagmus, H55.02 — Latent nystagmus, H55.03 — Visual deprivation nystagmus, H55.04 — Dissociated nystagmus, H55.09 — Other forms of nystagmus, H55.81 — Deficient saccadic eye movements, H55.82 — Deficient smooth pursuit eye movements, H55.89 — Other irregular eye movements, +260 more

Same Index main term, other category

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

E63.9 — Nutritional deficiency, unspecified (dietary), F51.12 — Insufficient sleep syndrome (sleep syndrome), G45.0 — Vertebro-basilar artery syndrome (arterial, basilar), G45.1 — Carotid artery syndrome (hemispheric) (arterial, carotid), G45.2 — Multiple and bilateral precerebral artery syndromes (arterial, precerebral), G45.8 — Other transient cerebral ischemic attacks and related syndromes (cerebrovascular, with transient focal neurological signs and symptoms), G90.09 — Other idiopathic peripheral autonomic neuropathy (idiopathic autonomic), H04.12 — Dry eye syndrome (lacrimal), H50.52 — Exophoria, H50.9 — Unspecified strabismus (muscle, ocular NEC), H52.4 — Presbyopia (accommodation, old age), I01.1 — Acute rheumatic endocarditis (mitral, rheumatic, active or acute), I01.2 — Acute rheumatic myocarditis (myocardial, myocardium, rheumatic, active, acute, or subacute), I02.0 — Rheumatic chorea with heart involvement (mitral, rheumatic, active or acute, with chorea, rheumatic), I05.1 — Rheumatic mitral insufficiency (mitral, rheumatic), I05.2 — Rheumatic mitral stenosis with insufficiency (mitral, with, obstruction or stenosis), I06.1 — Rheumatic aortic insufficiency (aortic, rheumatic), I06.2 — Rheumatic aortic stenosis with insufficiency (aortic, rheumatic, with, stenosis), I07.1 — Rheumatic tricuspid insufficiency (tricuspid), I07.2 — Rheumatic tricuspid stenosis and insufficiency (tricuspid, with, obstruction or stenosis), +75 more

Contextual Map

Every relationship of H51.11 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.

Hierarchy

• H00-H59 — Chapter 7: Diseases of the Eye and Adnexa (H00-H59) (H00-H59)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H49-H52 — Disorders of ocular muscles, binocular movement, accommodation and refraction[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Clinical classification (CCSR)

• EYE012 — Other specified eye disorders[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• DRG 124 — OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT[MS-DRG]: “OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT (MDC 02)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 125 — OTHER DISORDERS OF THE EYE WITHOUT MCC[MS-DRG]: “OTHER DISORDERS OF THE EYE WITHOUT MCC (MDC 02)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

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 · FY2026

Index entries

• Disorder (of), binocular, movement, convergence, insufficiency[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Exophoria, convergence, insufficiency[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Insufficiency, insufficient, convergence[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (11)

• H51 — Other disorders of binocular movement[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H51.0 — Palsy (spasm) of conjugate gaze[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H51.1 — Convergence insufficiency and excess[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H51.12 — Convergence excess[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H51.2 — Internuclear ophthalmoplegia[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H51.20 — Internuclear ophthalmoplegia, unspecified eye[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H51.21 — Internuclear ophthalmoplegia, right eye[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H51.22 — Internuclear ophthalmoplegia, left eye[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 3 more

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 FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 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 — v43 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

Nearest Codes in This Family

Official ICD-10-CM classifications closest to H51.11 in its code family, with their registry titles.

• H51 — Other disorders of binocular movement
• H51.0 — Palsy (spasm) of conjugate gaze
• H51.1 — Convergence insufficiency and excess
• H51.12 — Convergence excess
• H51.2 — Internuclear ophthalmoplegia
• H51.20 — Internuclear ophthalmoplegia, unspecified eye
• H51.21 — Internuclear ophthalmoplegia, right eye
• H51.22 — Internuclear ophthalmoplegia, left eye
• H51.23 — Internuclear ophthalmoplegia, bilateral
• H51.8 — Other specified disorders of binocular movement

View all codes in the H51 family