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H54.60 ICD-10-CM Code: Unqualified visual loss, one eye, unspecified

Compare with another codeCheck this code on a claim

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

Coding at a Glance

Tabular directives
1 Excludes1 · 1 code-first instruction

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too; the Instructions section marks which is which.

Code firstSequence the underlying condition before this code
  • any associated underlying cause of the blindness
Excludes1Never report with this code

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

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 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 H54.60 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 H54.60 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 H54

Code First

Underlying conditions that must be sequenced before this code.

  • any associated underlying cause of the blindness

Source: inherited from H54

Coder workflow for H54.60

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

Before you code H54.60

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, H54.60 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).

    ReviewH54.61, H54.62

    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).

    See the relationships section · Guide: Laterality coding →

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with H54.60. 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 record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — H54.60 is appropriate when the documentation goes no further.

    ReviewH54.61, H54.62

  2. Does the documentation support a condition named in H54.60’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.

    ReviewG45.3

  3. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then H54.60.
    No → Continue; do not add an underlying condition the record does not document.
  4. 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.

Consider H54.60. 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).
The underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.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

  • Excludes1 — check before selecting H54.60(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with H54.60: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareG45.3

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

  • Code First — sequencing check(1 note)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before H54.60. Do not add an underlying condition the record does not document.

    See the official tabular notes · Guidelines I.A.13

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).

ReviewH54.61, H54.62

Documentation: Both the condition H54.60 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).

ReviewG45.3

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).

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.

Coding context

The comparisons, hierarchy, index entries, guidelines, relationships, risk-adjustment and coverage context a coder commonly needs. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Don’t confuse H54.60 with…

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

The codes most likely to be picked instead of H54.60 — 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.

  • G45.3— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of amaurosis fugax moves the case to G45.3; the two are not reported together unless documented as unrelated.

    Full comparison: H54.60 vs G45.3 →

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

Unqualified visual loss, one eye, unspecified is a billable ICD-10-CM diagnosis code (H54.60).

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

Indexed Clinical Terms (1)

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.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 7: Diseases of the Eye and Adnexa (H00-H59)

b. Blindness If “blindness” or “low vision” of both eyes is documented but the visual impairment category is not documented, assign code H54.3, Unqualified visual loss, both eyes. If “blindness” or “low vision” in one eye is documented but the visual impairment category is not documented, assign a code from H54.6-, Unqualified visual loss, one eye. If “blindness” or “visual loss” is documented without any information about whether one or both eyes are affected, assign code H54.7, Unspecified visual loss.

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-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name H54.60 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 Use Additional Code instruction: S04.0 — Injury of optic nerve and pathways (via H54.-).

These codes instruct coders to additionally report this code when it applies.

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 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):EYE010 — Blindness and vision defects (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 (Blindness and vision defects).

H54.41 — Blindness, right eye, normal vision left eye, H54.413A — Blindness right eye category 3, normal vision left eye, H54.414A — Blindness right eye category 4, normal vision left eye, H54.415A — Blindness right eye category 5, normal vision left eye, H54.42 — Blindness, left eye, normal vision right eye, H54.42A3 — Blindness left eye category 3, normal vision right eye, H54.42A4 — Blindness left eye category 4, normal vision right eye, H54.42A5 — Blindness left eye category 5, normal vision right eye, H54.50 — Low vision, one eye, unspecified eye, H54.51 — Low vision, right eye, normal vision left eye, H54.511A — Low vision right eye category 1, normal vision left eye, H54.512A — Low vision right eye category 2, normal vision left eye, H54.52 — Low vision, left eye, normal vision right eye, H54.52A1 — Low vision left eye category 1, normal vision right eye, H54.52A2 — Low vision left eye category 2, normal vision right eye, H54.61 — Unqualified visual loss, right eye, normal vision left eye, H54.62 — Unqualified visual loss, left eye, normal vision right eye, H54.7 — Unspecified visual loss, H54.8 — Legal blindness, as defined in USA, Z45.31 — Encounter for adjustment and management of implanted visual substitution device, +116 more

Same Index main term, other category

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

E86.9 — Volume depletion, unspecified (fluid), F06.8 — Other specified mental disorders due to known physiological condition (memory, mild, following organic brain damage), F44.6 — Conversion disorder with sensory symptom or deficit (sensory, dissociative), F50.89 — Other specified eating disorder (appetite, hysterical), F52.0 — Hypoactive sexual desire disorder (sexual desire), F98.1 — Encopresis not due to a substance or known physiological condition (control, sphincter, rectum, nonorganic origin), H15.89 — Other disorders of sclera (substance of, vitreous), H53.12 — Transient visual loss (vision, visual, subjective, transient), H53.13 — Sudden visual loss (vision, visual, subjective, sudden), H74.32 — Partial loss of ear ossicles (ossicles, ear), H90.0 — Conductive hearing loss, bilateral (hearing, conductive, bilateral), H90.1 — Conductive hearing loss, unilateral with unrestricted hearing on the contralateral side (hearing, conductive, unilateral, with, unrestricted hearing on the contralateral side), H90.2 — Conductive hearing loss, unspecified (hearing, conductive), H90.3 — Sensorineural hearing loss, bilateral (hearing, sensorineural NOS, bilateral), H90.4 — Sensorineural hearing loss, unilateral with unrestricted hearing on the contralateral side (hearing, sensorineural NOS, unilateral, with, unrestricted hearing on the contralateral side), H90.5 — Unspecified sensorineural hearing loss (hearing, neural NOS), H90.6 — Mixed conductive and sensorineural hearing loss, bilateral (hearing, mixed conductive and sensorineural hearing loss, bilateral), H90.7 — Mixed conductive and sensorineural hearing loss, unilateral with unrestricted hearing on the contralateral side (hearing, mixed conductive and sensorineural hearing loss, unilateral, with, unrestricted hearing on the contralateral side), H90.8 — Mixed conductive and sensorineural hearing loss, unspecified (hearing, mixed conductive and sensorineural hearing loss), H90.A1 — Conductive hearing loss, unilateral, with restricted hearing on the contralateral side (hearing, conductive, unilateral, with, restricted hearing on the contralateral side), +16 more

Contextual Map

Every relationship of H54.60 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 H54.60 with this related code in Claim Check

Hierarchy

Referenced by Use Additional Code instructions

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

Index entries

  • Loss (of), vision, visual, one eye[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

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

Deep reference

Published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

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
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section 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-derived 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 editorial 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 20, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

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. "H54.60 — Unqualified visual loss, one eye, unspecified." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/h54.60-unqualified-visual-loss-one-eye-unspecified

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Unqualified visual loss, one eye, unspecified

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 H54.60 in its code family, with their registry titles.

View all codes in the H54 family