ICD-10-CM 2027
ICD-10 code for paralytic strabismus
From the official ICD-10-CM alphabetic index entry “Strabismus (congenital) (nonparalytic) › paralytic”. Page updated September 29, 2026.
About coding paralytic strabismus
The ICD-10-CM code for paralytic strabismus is H49.9 (Unspecified paralytic strabismus). The official index lists 10 more specific codes, so check the documentation for details such as type, cause, site or severity before settling on H49.9.
Within H49, choose H49.9 (Unspecified paralytic strabismus) only when documentation doesn't support a more specific option: third [oculomotor] nerve palsy (H49.0), fourth [trochlear] nerve palsy (H49.1), sixth [abducent] nerve palsy (H49.2), total (external) ophthalmoplegia (H49.3), progressive external ophthalmoplegia (H49.4) and other paralytic strabismus (H49.8).
It is not a CC or MCC, so as a secondary diagnosis it doesn't change the MS-DRG severity level.
In MS-DRG v44.0, it is part of the grouping logic for DRG 123 (Neurological Eye Disorders, relative weight 0.822), in MDC 02 (Diseases and Disorders of the Eye), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.
More specific paralytic strabismus codes (official index)
- abducens nerve H49.2 — Sixth [abducent] nerve palsy
- fourth nerve H49.1 — Fourth [trochlear] nerve palsy
- Kearns-Sayre syndrome H49.81 — Kearns-Sayre syndrome
- ophthalmoplegia (external)
- progressive H49.4 — Progressive external ophthalmoplegia
- with pigmentary retinopathy H49.81 — Kearns-Sayre syndrome
- total H49.3 — Total (external) ophthalmoplegia
- sixth nerve H49.2 — Sixth [abducent] nerve palsy
- specified type NEC H49.88 — Other paralytic strabismus
- third nerve H49.0 — Third [oculomotor] nerve palsy
- trochlear nerve H49.1 — Fourth [trochlear] nerve palsy
Common questions about paralytic strabismus ICD-10 codes
What is the ICD-10 code for paralytic strabismus?
- H49.9 — Unspecified paralytic strabismus. More specific codes apply when the documentation supports them: H49.2, H49.1, H49.81, H49.4 and others below.
What is the ICD-10 code for abducens nerve paralytic strabismus?
- H49.2 — Sixth [abducent] nerve palsy (header code; choose a more specific subcode).
What is the ICD-10 code for fourth nerve paralytic strabismus?
- H49.1 — Fourth [trochlear] nerve palsy (header code; choose a more specific subcode).
What is the ICD-10 code for kearns-sayre syndrome paralytic strabismus?
- H49.81 — Kearns-Sayre syndrome (header code; choose a more specific subcode).
What is the ICD-10 code for sixth nerve paralytic strabismus?
- H49.2 — Sixth [abducent] nerve palsy (header code; choose a more specific subcode).
What is the ICD-10 code for third nerve paralytic strabismus?
- H49.0 — Third [oculomotor] nerve palsy (header code; choose a more specific subcode).
What is the ICD-10 code for trochlear nerve paralytic strabismus?
- H49.1 — Fourth [trochlear] nerve palsy (header code; choose a more specific subcode).
Is H49.9 billable?
- Yes. H49.9 is a billable/specific ICD-10-CM code valid for FY2027 (October 1, 2026 – September 30, 2027).
Can H49.9 be used as a principal diagnosis?
- Yes. The Medicare Code Editor doesn't restrict H49.9 as a principal diagnosis.
Is H49.9 a CC or MCC?
- No. H49.9 is neither a CC nor an MCC under MS-DRG v44.0.