2027 ICD-10-CM Diagnosis Code H26.061Combined forms of infantile and juvenile cataract, right eye

ICD-10-CM Codes›H00–H59›H25-H28›H26

ICD-10-CM H26.061
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

H26.061 is a billable ICD-10-CM diagnosis code for combined forms of infantile and juvenile cataract, right eye. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 124 through 125. The code is restricted by the Medicare Code Editor to pediatric patients (age 0 through 17). In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Cataract and other lens disorders.

Code Identity

ICD-10-CM Code
H26.061
Billable Status
Yes — Valid for Submission
Code Describes
Combined forms of infantile and juvenile cataract, right eye
Short Description
Combined forms of infantile and juvenile cataract, right eye
Same as the full description in the CMS dataset.
Parent Code
H26.06
Combined forms of infantile and juvenile cataract

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH25-H28Disorders of lens
CategoryH26Other cataract
This CodeH26.061Combined forms of infantile and juvenile cataract, right eye

Code EditsBilling

Medicare Code Editor checks that affect claim validity for H26.061.

Pediatric diagnoses
The Medicare Code Editor detects inconsistencies in pediatric cases by checking a patient's age and any diagnosis on the patient's record. The pediatric code edits apply to patients age range is 0–17 years inclusive (e.g., Reye's syndrome, routine child health exam).

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to H26.061: its own notes plus those printed at H26 and Chapter 7. A note printed at a category, block or chapter applies to every code under it.

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From H26 Other cataract applies to 69 codes
  • congenital cataract (Q12.0)

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From Chapter 7 (H00-H59) Diseases of the eye and adnexa applies to 2,677 codes
  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
  • diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury (trauma) of eye and orbit (S05.-)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
  • syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)

Notes

General instructions on how these codes are used.

From Chapter 7 (H00-H59) Diseases of the eye and adnexa applies to 2,677 codes
  • Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR EYE002
Cataract and other lens disorders
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Cataract

A cataract is a clouding of the clear lens inside your eye. This cloudiness blocks light from reaching the back of the eye, making it harder to see clearly. A cataract can affect one or both eyes, but it doesn't spread from one eye to the other.

The full article covers:

  • What are cataracts?
  • What causes cataracts?
  • Who is more likely to develop cataracts?
  • What are the symptoms of cataracts?
  • How are cataracts diagnosed?
  • How are cataracts treated?
  • Can cataracts be prevented?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert H26.061 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
366.09 Nonsenile cataract NEC
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About H26.061Overview

What is the ICD-10 code for combined forms of infantile and juvenile cataract, right eye?

The ICD-10-CM code for combined forms of infantile and juvenile cataract, right eye is H26.061 (sometimes written as H26061). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is H26.061 (Combined forms of infantile and juvenile cataract) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report combined forms of infantile and juvenile cataract, right eye on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does H26.061 group to?

When combined forms of infantile and juvenile cataract, right eye is the principal diagnosis on an inpatient stay, it groups to MS-DRG 125, 124, with relative weights from 0.7699 to 1.2470 depending on complications. Higher weights mean higher Medicare reimbursement.

Who can H26.061 be reported for?

The Medicare Code Editor checks combined forms of infantile and juvenile cataract, right eye against patient demographics: this code is intended for pediatric patients (age 0 through 17). Claims outside these limits are flagged as inconsistent.

Can H26.061 be reported with Q12.0?

Not as a rule. The Excludes1 note at H26, which applies to H26.061, lists "congenital cataract (Q12.0)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).