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H52.12 ICD-10-CM Code: Myopia, left eye

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

Coding at a Glance

Tabular directives
1 Excludes1 · 1 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 v43, Appendix B.

  • MS-DRG 124 — OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT (MDC 02)
  • MS-DRG 125 — OTHER DISORDERS OF THE EYE WITHOUT MCC (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 H52.12 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 H52.12 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from H52.1

Excludes2 — Not Included Here

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

Source: inherited from H49-H52

Coder workflow for H52.12

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

Before you code H52.12

  1. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: left). 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).

    ReviewH52.11 · right, H52.13 · bilateral, H52.10 · unspecified

    Guide: Laterality coding →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with H52.12. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in H52.12’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewH44.2

  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.

    ReviewH52.11 · right, H52.13 · bilateral, H52.10 · unspecified

Consider H52.12. 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).

Official instructions as workflow

  • Excludes1 — check before selecting H52.12(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with H52.12: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareH44.2

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

  • Excludes2 — not part of H52.12(1 note)

    Coding workflow: The conditions named in this note are not included in H52.12. 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

Coding decision scenarios

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

Documentation: Both the condition H52.12 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewH44.2

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).

ReviewH52.11 · right, H52.13 · bilateral, H52.10 · unspecified

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.

Code Overview

Myopia, left eye is a billable ICD-10-CM diagnosis code (H52.12).

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

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
  2. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  3. 1 Excludes2 entry — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

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):EYE009 — Refractive error (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 condition, opposite side

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

H52.10 — Myopia, unspecified eye (unspecified)Compare H52.12 vs H52.10 →, H52.11 — Myopia, right eye (right)Compare H52.12 vs H52.11 →, H52.13 — Myopia, bilateral (bilateral)Compare H52.12 vs H52.13 →

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Refractive error).

H52.00 — Hypermetropia, unspecified eye, H52.01 — Hypermetropia, right eye, H52.02 — Hypermetropia, left eye, H52.03 — Hypermetropia, bilateral, H52.10 — Myopia, unspecified eye, H52.11 — Myopia, right eye, H52.13 — Myopia, bilateral, H52.201 — Unspecified astigmatism, right eye, H52.202 — Unspecified astigmatism, left eye, H52.203 — Unspecified astigmatism, bilateral, H52.209 — Unspecified astigmatism, unspecified eye, H52.211 — Irregular astigmatism, right eye, H52.212 — Irregular astigmatism, left eye, H52.213 — Irregular astigmatism, bilateral, H52.219 — Irregular astigmatism, unspecified eye, H52.221 — Regular astigmatism, right eye, H52.222 — Regular astigmatism, left eye, H52.223 — Regular astigmatism, bilateral, H52.229 — Regular astigmatism, unspecified eye, H52.31 — Anisometropia, +16 more

Same Index main term, other category

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

H44.2 — Degenerative myopia (malignant), H44.20 — Degenerative myopia, unspecified eye (degenerative), H44.21 — Degenerative myopia, right eye (degenerative, right eye), H44.22 — Degenerative myopia, left eye (degenerative, left eye), H44.23 — Degenerative myopia, bilateral (degenerative, bilateral), H44.2A — Degenerative myopia with choroidal neovascularization (degenerative, with, choroidal neovascularization), H44.2B — Degenerative myopia with macular hole (degenerative, with, macular hole), H44.2C — Degenerative myopia with retinal detachment (degenerative, with, retinal detachment), H44.2D — Degenerative myopia with foveoschisis (degenerative, with, foveoschisis), H44.2E — Degenerative myopia with other maculopathy (degenerative, with, specified maculopathy NEC)

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

Contextual Map

Every relationship of H52.12 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

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 · FY2026

Nearest codes (40)

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

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. "H52.12 — Myopia, left eye." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/h52.12-myopia-left-eye

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Myopia, left eye

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), 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 H52.12 in its code family, with their registry titles.

View all codes in the H52 family