2027 ICD-10-CM Diagnosis Code H43.01Vitreous prolapse, right eye
ICD-10-CM Codes›H00–H59›H43-H44›H43
- Billable — Valid for Submission
- Chronic Condition
H43.01 is a billable ICD-10-CM diagnosis code for vitreous prolapse, 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. Coders also document this condition as vitreous prolapse. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Retinal and vitreous conditions.
Code Identity
Code Classification
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Vitreous prolapse
- Vitreous prolapse of right eye
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to H43.01: its own notes plus those printed at H43.0 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.
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.
- 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.
- 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.
Patient EducationClinical
Eye Diseases
Even if your eyes feel healthy, you could have a problem and not know it. That's why regular eye exams are so important. Refractive errors are the most common type of vision problem that makes it hard to see clearly. But some eye conditions or diseases don't have any symptoms and can lead to a permanent loss of vision.
The full article covers:
- What diseases can affect the eye?
- What are the symptoms of eye diseases?
- Who is more likely to develop eye diseases?
- What are the treatments for eye diseases?
- Can eye diseases be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert H43.01 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About H43.01Overview
What is the ICD-10 code for vitreous prolapse, right eye?
The ICD-10-CM code for vitreous prolapse, right eye is H43.01 (sometimes written as H4301). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is H43.01 (Vitreous prolapse) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report vitreous prolapse, right eye on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does H43.01 group to?
When vitreous prolapse, 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.
Can H43.01 be reported with a code from H59.0?
Not as a rule. The Excludes1 note at H43.0, which applies to H43.01, lists "vitreous syndrome following cataract surgery (H59.0-)". 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 H43.01?
Under the General Equivalence Mappings, vitreous prolapse, right eye converts to ICD-9-CM 379.26 (vitreous prolapse). The mapping is approximate, so confirm the match fits the documentation.
