H52.4 ICD-10-CM Code: Presbyopia

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for H52.4 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 H52.4 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for H52.4

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 H52.4(1 note)

  Coding workflow: The conditions named in this note are not included in H52.4. 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 (5)

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.

• Accommodation (disorder), insufficiency of
• Disorder (of), refraction, presbyopia
• Insufficiency, insufficient, accommodation, old age
• Presbyopia
• Subnormal, subnormality, accommodation (old age)

Don’t confuse H52.4 with…

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

The codes most likely to be picked instead of H52.4 — 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: H52.4 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):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 clinical category (CCSR)

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

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, H52.32 — Aniseikonia, H52.511 — Internal ophthalmoplegia (complete) (total), right eye, H52.512 — Internal ophthalmoplegia (complete) (total), left eye, H52.513 — Internal ophthalmoplegia (complete) (total), bilateral, H52.519 — Internal ophthalmoplegia (complete) (total), unspecified eye, H52.521 — Paresis of accommodation, right eye, H52.522 — Paresis of accommodation, left eye, H52.523 — Paresis of accommodation, bilateral, H52.529 — Paresis of accommodation, unspecified eye, H52.531 — Spasm of accommodation, right eye, H52.532 — Spasm of accommodation, left eye, +16 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”, “Accommodation”; these codes share that main term but sit in a different category of the Tabular List.

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), H50.9 — Unspecified strabismus (muscle, ocular NEC), H51.11 — Convergence insufficiency (convergence), H51.8 — Other specified disorders of binocular movement (divergence), 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), I08.0 — Rheumatic disorders of both mitral and aortic valves (aortic, with, mitraldisease), +77 more

Contextual Map

Every relationship of H52.4 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)

• EYE009 — Refractive error[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

• Accommodation (disorder), insufficiency of[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Disorder (of), refraction, presbyopia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Insufficiency, insufficient, accommodation, old age[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Presbyopia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Subnormal, subnormality, accommodation (old age)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (40)

• H52 — Disorders of refraction and accommodation[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H52.11 — Myopia, right eye[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H52.12 — Myopia, left eye[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H52.13 — Myopia, bilateral[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H52.2 — Astigmatism[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H52.20 — Unspecified astigmatism[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H52.201 — Unspecified astigmatism, right eye[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H52.202 — Unspecified astigmatism, left eye[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 32 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 H52.4 in its code family, with their registry titles.

• H52.223 — Regular astigmatism, bilateral
• H52.229 — Regular astigmatism, unspecified eye
• H52.3 — Anisometropia and aniseikonia
• H52.31 — Anisometropia
• H52.32 — Aniseikonia
• H52.5 — Disorders of accommodation
• H52.51 — Internal ophthalmoplegia (complete) (total)
• H52.511 — Internal ophthalmoplegia (complete) (total), right eye
• H52.512 — Internal ophthalmoplegia (complete) (total), left eye
• H52.513 — Internal ophthalmoplegia (complete) (total), bilateral

View all codes in the H52 family