H81.4 ICD-10-CM Code: Vertigo of central origin

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for H81.4 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 H81.4 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for H81.4

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

Before you code H81.4

1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with H81.4. 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 H81.4’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.

   ReviewA88.1, R42

Consider H81.4. 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).

Official instructions as workflow

• Excludes1 — check before selecting H81.4(2 notes)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with H81.4: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareA88.1, R42

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

Coding decision scenarios

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

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 (7)

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.

• Nystagmus, central positional
• Nystagmus, positional, benign paroxysmal
• Nystagmus, positional, central
• Vertigo, central (origin)
• Vertigo, cerebral
• Vertigo, malignant positional
• Vertigo, positional, malignant

Official Coding Guidelines

No excerpt in the ICD-10-CM Official Guidelines names this code specifically. Its chapter carries only this chapter-wide note:

Don’t confuse H81.4 with…

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

The codes most likely to be picked instead of H81.4 — 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.

• A88.1— 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 epidemic vertigo moves the case to A88.1; the two are not reported together unless documented as unrelated.

  Full comparison: H81.4 vs A88.1 →

• R42— 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 vertigo NOS moves the case to R42; the two are not reported together unless documented as unrelated.

  Full comparison: H81.4 vs R42 →

• H81.9— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Unspecified disorder of vestibular function” takes H81.9; specificity in the record moves it back here.

  Full comparison: H81.4 vs H81.9 →

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

Other codes that name H81.4 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 Excludes1 note: R42 — Dizziness and giddiness (via H81.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

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 1 MS-DRG: DRG 149 (MDC 03).

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

Clinical classification (AHRQ CCSR):EAR003 — Diseases of inner ear and related conditions (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 (Diseases of inner ear and related conditions).

H81.22 — Vestibular neuronitis, left ear, H81.23 — Vestibular neuronitis, bilateral, H81.311 — Aural vertigo, right ear, H81.312 — Aural vertigo, left ear, H81.313 — Aural vertigo, bilateral, H81.319 — Aural vertigo, unspecified ear, H81.391 — Other peripheral vertigo, right ear, H81.392 — Other peripheral vertigo, left ear, H81.393 — Other peripheral vertigo, bilateral, H81.399 — Other peripheral vertigo, unspecified ear, H81.8X1 — Other disorders of vestibular function, right ear, H81.8X2 — Other disorders of vestibular function, left ear, H81.8X3 — Other disorders of vestibular function, bilateral, H81.8X9 — Other disorders of vestibular function, unspecified ear, H81.90 — Unspecified disorder of vestibular function, unspecified ear, H81.91 — Unspecified disorder of vestibular function, right ear, H81.92 — Unspecified disorder of vestibular function, left ear, H81.93 — Unspecified disorder of vestibular function, bilateral, H82.1 — Vertiginous syndromes in diseases classified elsewhere, right ear, H82.2 — Vertiginous syndromes in diseases classified elsewhere, left ear, +56 more

Same Index main term, other category

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

A88.1 — Epidemic vertigo (epidemic), F44.89 — Other dissociative and conversion disorders (hysterical), H55.00 — Unspecified nystagmus, H55.01 — Congenital nystagmus (congenital), H55.02 — Latent nystagmus (latent), H55.03 — Visual deprivation nystagmus (visual deprivation), H55.04 — Dissociated nystagmus (dissociated), H55.09 — Other forms of nystagmus (miners'), N95.1 — Menopausal and female climacteric states (menopausal), R05.4 — Cough syncope (laryngeal), R42 — Dizziness and giddiness, T75.23 — Vertigo from infrasound (infrasound)

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.

Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of H81.4 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.

Run H81.4 with this related code in Claim Check

Hierarchy

• H60-H95 — Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95) (H60-H95)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H80-H83 — Diseases of inner ear[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• R42 — Dizziness and giddiness[Excludes1](via H81.-): “vertiginous syndromes (H81.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• EAR003 — Diseases of inner ear and related conditions[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• DRG 149 — DYSEQUILIBRIUM[MS-DRG]: “DYSEQUILIBRIUM (MDC 03)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 03 — Diseases and Disorders of the Ear, Nose, Mouth and Throat[MDC crossing]: “Diseases and Disorders of the Ear, Nose, Mouth and Throat — 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. 5,147 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Nystagmus, central positional[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Nystagmus, positional, benign paroxysmal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Nystagmus, positional, central[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Vertigo, central (origin)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Vertigo, cerebral[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Vertigo, malignant positional[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Vertigo, positional, malignant[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (38)

• H81 — Disorders of vestibular function[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H81.0 — Ménière's disease[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H81.01 — Ménière's disease, right ear[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H81.02 — Ménière's disease, left ear[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H81.03 — Ménière's disease, bilateral[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H81.09 — Ménière's disease, unspecified ear[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H81.1 — Benign paroxysmal vertigo[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H81.10 — Benign paroxysmal vertigo, unspecified ear[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 30 more

Change history (2)

• FY2020 — Became valid for submission[Change history]— CMS release files (code change ledger) · icd10cm-fy2020
• and 1 more

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

Coding guidelines Official source data

ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section 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 H81.4 in its code family, with their registry titles.

• H81.39 — Other peripheral vertigo
• H81.391 — Other peripheral vertigo, right ear
• H81.392 — Other peripheral vertigo, left ear
• H81.393 — Other peripheral vertigo, bilateral
• H81.399 — Other peripheral vertigo, unspecified ear
• H81.8 — Other disorders of vestibular function
• H81.8X — Other disorders of vestibular function
• H81.8X1 — Other disorders of vestibular function, right ear
• H81.8X2 — Other disorders of vestibular function, left ear
• H81.8X3 — Other disorders of vestibular function, bilateral

View all codes in the H81 family