2027 ICD-10-CM Diagnosis Code H26.20Unspecified complicated cataract

ICD-10-CM Codes›H00–H59›H25-H28›H26

ICD-10-CM H26.20
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

H26.20 is a billable ICD-10-CM diagnosis code for unspecified complicated cataract. 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. Coders also document this condition as cataract due to ocular disease. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Cataract and other lens disorders.

Code Identity

ICD-10-CM Code
H26.20
Billable Status
Yes — Valid for Submission
Code Describes
Unspecified complicated cataract
Short Description
Unspecified complicated cataract
Same as the full description in the CMS dataset.
Parent Code
H26.2
Complicated cataract

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH25-H28Disorders of lens
CategoryH26Other cataract
This CodeH26.20Unspecified complicated cataract

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Cataract due to ocular disease
  • Cataract of left eye due to ocular disease
  • Cataract of lens capsule of bilateral eyes
  • Complicated cataract of bilateral eyes
  • Complicated cataract of left eye
  • Complicated cataract of right eye

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to H26.20: 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.

Applicable To

Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.

  • Cataracta complicata NOS

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.

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

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 H26.20 to ICD-9-CMHistory

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

ICD-9-CM
366.30 Cataracta complicata NOS
Exact Match The mapping is direct, with no qualifiers.

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 H26.20Overview

What is the ICD-10 code for unspecified complicated cataract?

The ICD-10-CM code for unspecified complicated cataract is H26.20 (sometimes written as H2620). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is H26.20 (Complicated cataract) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report unspecified complicated cataract on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does H26.20 group to?

When unspecified complicated cataract 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.

Can H26.20 be reported with Q12.0?

Not as a rule. The Excludes1 note at H26, which applies to H26.20, 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).

What is the ICD-9 equivalent of H26.20?

Under the General Equivalence Mappings, unspecified complicated cataract converts to ICD-9-CM 366.30 (cataracta complicata NOS). The mapping is a direct match.