2026 ICD-10-CM Diagnosis Code H53.043Amblyopia suspect, bilateral

ICD-10-CM Codes›H00–H59›H53-H54›H53

ICD-10-CM H53.043
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

H53.043 is a billable ICD-10-CM diagnosis code for amblyopia suspect, bilateral. 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 amblyopia of bilateral eyes suspected. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Blindness and vision defects.

Code Identity

ICD-10-CM Code
H53.043
Billable Status
Yes — Valid for Submission
Code Describes
Amblyopia suspect, bilateral
Short Description
Amblyopia suspect, bilateral
Same as the full description in the CMS dataset.
Parent Code
H53.04
Amblyopia suspect

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH53-H54Visual disturbances and blindness
CategoryH53Visual disturbances
This CodeH53.043Amblyopia suspect, bilateral

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Amblyopia of bilateral eyes suspected
  • Amblyopia of left eye suspected
  • Amblyopia of right eye suspected

Clinical ClassificationClinical

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

CCSR EYE010
Blindness and vision defects
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Amblyopia

Amblyopia, or "lazy eye," is the most common cause of visual impairment in children. It happens when an eye fails to work properly with the brain. The eye may look normal, but the brain favors the other eye. In some cases, it can affect both eyes. Causes include:

Read the full article at MedlinePlus

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

Convert H53.043 to ICD-9-CMHistory

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

ICD-9-CM
368.8 Visual disturbances NEC
Approximate The match is approximate rather than exact.

Code History & ChangesHistory

Replacement H53.043 replaces the following previously assigned code(s):

  • H53.003 - Unspecified amblyopia, bilateral
FY 2018AddedAdded to the ICD-10-CM code setEffective October 1, 2017.
FY 2019–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About H53.043Overview

Is H53.043 (Amblyopia suspect) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report amblyopia suspect, bilateral on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does H53.043 group to?

When amblyopia suspect, bilateral 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 H53.043?

Under the General Equivalence Mappings, amblyopia suspect, bilateral converts to ICD-9-CM 368.8 (visual disturbances NEC). The mapping is approximate, so confirm the match fits the documentation.

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.