H54.40

Documentation support

General coding-documentation guidance — not a substitute for payer-specific requirements or professional coding judgment.

• •This code describes an unspecified presentation. If the medical record documents a more specific detail (e.g. laterality, type, or affected site), a more specific sibling code should be used instead — see Related codes below.
• •Laterality-specific codes exist for this condition — confirm the affected side is documented.
• •As a general rule, code to the highest level of specificity supported by the documentation in the medical record.

ICD-9-CM equivalent

Informational only — GEM mappings are approximate, not guaranteed one-to-one equivalents. Verify before use in billing.

• 36902Approximate match
• 36905Approximate match
• 36960Approximate match
• 36961Approximate match
• 36964Approximate match
• 36966Approximate match
• 36967Approximate match

Associated MS-DRGs

H54.40 can serve as the principal diagnosis for these Medicare Severity Diagnosis-Related Groups.

Informational only — actual DRG assignment also depends on procedures, complications/comorbidities (CC/MCC), discharge status, and payer-specific rules not reflected here.

• DRG 102Headaches with MCC
• DRG 103Headaches without MCC
• DRG 124Other Disorders of the Eye with MCC or Thrombolytic Agent
• DRG 125Other Disorders of the Eye without MCC