2027 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 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

H53.043 is a billable ICD-10-CM diagnosis code for amblyopia suspect, bilateral. 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 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

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to H53.043: its own notes plus those printed at H53.0 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.

From H53.0 Amblyopia ex anopsia applies to 20 codes
  • amblyopia due to vitamin A deficiency (E50.5)

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

Clinical InformationClinical

  • Visual Disturbance

    an interference to normal eyesight.

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 2019AddedAdded to the ICD-10-CM code setEffective October 1, 2018.
FY 2020–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About H53.043Overview

What is the ICD-10 code for amblyopia suspect, bilateral?

The ICD-10-CM code for amblyopia suspect, bilateral is H53.043 (sometimes written as H53043). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

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, 2026 through September 30, 2027.

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 125, 124, with relative weights from 0.7699 to 1.2470 depending on complications. Higher weights mean higher Medicare reimbursement.

Can H53.043 be reported with E50.5?

Not as a rule. The Excludes1 note at H53.0, which applies to H53.043, lists "amblyopia due to vitamin A deficiency (E50.5)". 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 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.