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Ophthalmology and Optometry Coding Alert

You Be the Coder:

Keep Strabismus Types Straight for Correct Coding

Published on Tue May 23, 2023

Question: Our ophthalmologist diagnosed a patient with monocular esotropia in the right eye, with a V pattern. Can you explain the different types of strabismus and how to figure out which diagnosis code to report in this case?

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Answer: Strabismus occurs when the eyes are not aligned properly. One or both of a patient’s eyes may turn inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia). The ICD-10-CM diagnosis codes for strabismus include H49- (Paralytic strabismus) and H50- (Other strabismus). The first two subcategories under H50- are broken down to specify:

  • Whether the condition is esotropia (convergent horizontal strabismus) or exotropia (divergent horizontal strabismus)
  • Monocular or alternating
  • Which pattern the patient displays
  • Which eyes (left, right, both, or unspecified) are affected.

In this case, you would report H50.031 (Monocular esotropia with V pattern, right eye). The rest of the esotropia code series describes the other manifestations of the condition:

  • H50.00 (Unspecified esotropia)
  • H50.011 (Monocular esotropia, right eye)
  • H50.012 (… left eye)
  • H50.021 (Monocular esotropia with A pattern, right eye)
  • H50.022 (… left eye)
  • H50.031 (Monocular esotropia with V pattern, right eye)
  • H50.032 (… left eye)
  • H50.041 (Monocular esotropia with other noncomitancies, right eye)
  • H50.042 (… left eye)
  • H50.05 (Alternating esotropia)
  • H50.06 (… with A pattern)
  • H50.07 (… with V pattern)
  • H50.08 (… with other noncomitancies)

The exotropia codes (H50.1-) follow a similar pattern.

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