2026 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 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

H26.20 is a billable ICD-10-CM diagnosis code for unspecified complicated cataract. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) 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

Tabular List NotesGuidance

Coding notes and annotation back-references applicable to this code.

Inclusion Terms

  • Cataracta complicata NOS

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

External Cause of Injuries IndexGuidance

References for this code in the External Cause of Injuries Index.

    • Cataract(cortical) (immature) (incipient)
      • complicated

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 lens in your eye. It affects your vision. Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.

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 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About H26.20Overview

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, 2025 through September 30, 2026.

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 124, 125, with relative weights from 0.7678 to 1.3231 depending on complications. Higher weights mean higher Medicare reimbursement.

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.

Footnotes

[1] Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:

  • The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
  • The condition places limitations on self-care, independent living, and social interactions.