2024 ICD-10-CM Diagnosis Code H49.9

Unspecified paralytic strabismus

ICD-10-CM Code:
H49.9
ICD-10 Code for:
Unspecified paralytic strabismus
Is Billable?
Yes - Valid for Submission
Chronic Condition Indicator: [1]
Not chronic
Code Navigator:

Code Classification

  • Diseases of the eye and adnexa
    (H00–H59)
    • Disorders of ocular muscles, binocular movement, accommodation and refraction
      (H49-H52)
      • Paralytic strabismus
        (H49)

H49.9 is a billable diagnosis code used to specify a medical diagnosis of unspecified paralytic strabismus. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.

Unspecified diagnosis codes like H49.9 are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

  • Acquired dysarthria
  • Combined malformation of central nervous system and skeletal muscle
  • Congenital nuclear ophthalmoplegia
  • Congenital plicated tongue
  • Gaucher disease with ophthalmoplegia and cardiovascular calcification
  • Gaucher's disease
  • Hereditary inclusion body myopathy, joint contracture, ophthalmoplegia syndrome
  • Hutchinson's facies
  • Myopathy with cytoplasmic inclusions
  • Ophthalmoplegia
  • Ophthalmoplegia due to abetalipoproteinemia
  • Ophthalmoplegia due to and following Guillain-Barré syndrome
  • Ophthalmoplegia due to neuropathy
  • Ophthalmoplegia due to neuropathy
  • Ophthalmoplegia due to neuropathy
  • Ophthalmoplegia due to phytanic acid storage disease
  • Ophthalmoplegia, intellectual disability, lingua scrotalis syndrome
  • Painful ophthalmoplegia
  • Paralysis of tongue
  • Paralytic strabismus
  • Paralytic strabismus of left eye
  • Paralytic strabismus of right eye
  • Paresis of extraocular muscles
  • Plicated tongue
  • Sensory ataxia
  • Sensory ataxic neuropathy with dysarthria and ophthalmoparesis syndrome
  • Sequela of Guillain Barre syndrome
  • Spinal atrophy, ophthalmoplegia, pyramidal syndrome
  • Subacute neuronopathic Gaucher's disease

Clinical Classification

Clinical CategoryCCSR Category CodeInpatient Default CCSROutpatient Default CCSR
Neuro-ophthalmologyEYE006Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.
StrabismusEYE007N - Not default inpatient assignment for principal diagnosis or first-listed diagnosis.N - Not default outpatient assignment for principal diagnosis or first-listed diagnosis.

Clinical Information

  • Horner Syndrome

    a syndrome associated with defective sympathetic innervation to one side of the face, including the eye. clinical features include miosis; mild blepharoptosis; and hemifacial anhidrosis (decreased sweating)(see hypohidrosis). lesions of the brain stem; cervical spinal cord; first thoracic nerve root; apex of the lung; carotid artery; cavernous sinus; and apex of the orbit may cause this condition. (from miller et al., clinical neuro-ophthalmology, 4th ed, pp500-11)
  • Kearns-Sayre Syndrome

    a mitochondrial disorder featuring the triad of chronic progressive external ophthalmoplegia, cardiomyopathy (cardiomyopathies) with conduction block (heart block), and retinitis pigmentosa. disease onset is in the first or second decade. elevated csf protein, sensorineural deafness, seizures, and pyramidal signs may also be present. ragged-red fibers are found on muscle biopsy. (adams et al., principles of neurology, 6th ed, p984)
  • Miller Fisher Syndrome

    a variant of the guillain-barre syndrome characterized by the acute onset of oculomotor dysfunction, ataxia, and loss of deep tendon reflexes with relative sparing of strength in the extremities and trunk. the ataxia is produced by peripheral sensory nerve dysfunction and not by cerebellar injury. facial weakness and sensory loss may also occur. the process is mediated by autoantibodies directed against a component of myelin found in peripheral nerves. (adams et al., principles of neurology, 6th ed, p1313; neurology 1987 sep;37(9):1493-8)
  • Niemann-Pick Disease, Type A

    the classic infantile form of niemann-pick disease, caused by mutation in sphingomyelin phosphodiesterase. it is characterized by accumulation of sphingomyelins in the cells of the mononuclear phagocyte system and other cell throughout the body leading to cell death. clinical signs include jaundice, hepatosplenomegaly, and severe brain damage.
  • Ocular Motility Disorders

    disorders that feature impairment of eye movements as a primary manifestation of disease. these conditions may be divided into infranuclear, nuclear, and supranuclear disorders. diseases of the eye muscles or oculomotor cranial nerves (iii, iv, and vi) are considered infranuclear. nuclear disorders are caused by disease of the oculomotor, trochlear, or abducens nuclei in the brain stem. supranuclear disorders are produced by dysfunction of higher order sensory and motor systems that control eye movements, including neural networks in the cerebral cortex; basal ganglia; cerebellum; and brain stem. ocular torticollis refers to a head tilt that is caused by an ocular misalignment. opsoclonus refers to rapid, conjugate oscillations of the eyes in multiple directions, which may occur as a parainfectious or paraneoplastic condition (e.g., opsoclonus-myoclonus syndrome). (adams et al., principles of neurology, 6th ed, p240)
  • Ophthalmoplegia

    paralysis of one or more of the ocular muscles due to disorders of the eye muscles, neuromuscular junction, supporting soft tissue, tendons, or innervation to the muscles.
  • Ophthalmoplegia, Chronic Progressive External

    a mitochondrial myopathy characterized by slowly progressive paralysis of the levator palpebrae, orbicularis oculi, and extraocular muscles. ragged-red fibers and atrophy are found on muscle biopsy. familial and sporadic forms may occur. disease onset is usually in the first or second decade of life, and the illness slowly progresses until usually all ocular motility is lost. (from adams et al., principles of neurology, 6th ed, p1422)
  • Supranuclear Palsy, Progressive

    a degenerative disease of the central nervous system characterized by balance difficulties; ocular motility disorders (supranuclear ophthalmoplegia); dysarthria; swallowing difficulties; and axial dystonia. onset is usually in the fifth decade and disease progression occurs over several years. pathologic findings include neurofibrillary degeneration and neuronal loss in the dorsal mesencephalon; subthalamic nucleus; red nucleus; pallidum; dentate nucleus; and vestibular nuclei. (from adams et al., principles of neurology, 6th ed, pp1076-7)
  • Guillain-Barre Syndrome

    an acute inflammatory autoimmune neuritis caused by t cell- mediated cellular immune response directed towards peripheral myelin. demyelination occurs in peripheral nerves and nerve roots. the process is often preceded by a viral or bacterial infection, surgery, immunization, lymphoma, or exposure to toxins. common clinical manifestations include progressive weakness, loss of sensation, and loss of deep tendon reflexes. weakness of respiratory muscles and autonomic dysfunction may occur. (from adams et al., principles of neurology, 6th ed, pp1312-1314)
  • Minicore Myopathy with External Ophthalmoplegia

    an autosomal recessive condition caused by mutation(s) in the ryr1 gene, encoding ryanodine receptor 1. it may be characterized clinically by neonatal hypotonia, delayed motor development, and generalized muscle weakness, and amyotrophy. pathologically, the absence of mitochondria and focal disorganization of the sarcomere appear as "minicores" on atpase staining as a result of focal defects in oxidative activity.
  • Ophthalmoplegia

    weakness or paralysis of at least one of the muscles controlling the movement of the eye. it results from degeneration of the muscles or the neural pathways involved in the eye movement. representative disorders causing ophthalmoplegia include ocular myopathies and multiple sclerosis.
  • Progressive Supranuclear Palsy|Progressive supranuclear ophthalmoplegia|Steele-Richardson-Olszewski Syndrome

    a rare neurodegenerative disorder characterized by gait and balance difficulties and loss of coordination of eye movements.

Index to Diseases and Injuries References

The following annotation back-references for this diagnosis code are found in the injuries and diseases index. The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10-CM code(s).

Convert H49.9 to ICD-9-CM

  • ICD-9-CM Code: 378.50 - Paralytic strabismus NOS
    Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Patient Education


Eye Movement Disorders

When you look at an object, you're using several muscles to move both eyes to focus on it. If you have a problem with the muscles, the eyes don't work properly.

There are many kinds of eye movement disorders. Two common ones are:

  • Strabismus - a disorder in which the two eyes don't line up in the same direction. This results in "crossed eyes" or "walleye."
  • Nystagmus - fast, uncontrollable movements of the eyes, sometimes called "dancing eyes"

Some eye movement disorders are present at birth. Others develop over time and may be associated with other problems, such as injuries. Treatments include glasses, patches, eye muscle exercises, and surgery. There is no cure for some kinds of eye movement disorders, such as most kinds of nystagmus.


[Learn More in MedlinePlus]

Code History

  • FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
  • FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
  • FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
  • FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.