2027 ICD-10-CM Diagnosis Code S04.011SInjury of optic nerve, right eye, sequela
S04.011S is a billable ICD-10-CM diagnosis code for injury of optic nerve, right eye, sequela. The 7th character S marks it as a sequela code, which reports a problem that remains after the original condition has resolved. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 91 through 93. The code is exempt from POA reporting. Coders also document this condition as bilateral injury of optic nerve. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Injury, sequela.
Code Identity
Code Classification
Present on Admission (POA)Billing
S04.011S is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Injuries to the head (S00-S09).
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Bilateral injury of optic nerve
- Injury of both visual cortices
- Injury of left visual cortex
- Injury of right visual cortex
- Traumatic injury of right optic nerve
- Traumatic injury of right visual pathway
- Traumatic optic nerve injury
Coding GuidelinesGuidance
The appropriate 7th character is to be added to each code from block Injury of cranial nerve (S04). Use the following options for the applicable episode of care:
- A - initial encounter
- D - subsequent encounter
- S - sequela
Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, published by CMS and the National Center for Health Statistics.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to S04.011S: its own notes plus those printed at S04.0, S04, block S00-S09, and Chapter 19. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- injuries of ear
- injuries of eye
- injuries of face [any part]
- injuries of gum
- injuries of jaw
- injuries of oral cavity
- injuries of palate
- injuries of periocular area
- injuries of scalp
- injuries of temporomandibular joint area
- injuries of tongue
- injuries of tooth
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.
- burns and corrosions (T20-T32)
- effects of foreign body in ear (T16)
- effects of foreign body in larynx (T17.3)
- effects of foreign body in mouth NOS (T18.0)
- effects of foreign body in nose (T17.0-T17.1)
- effects of foreign body in pharynx (T17.2)
- effects of foreign body on external eye (T15.-)
- frostbite (T33-T34)
- insect bite or sting, venomous (T63.4)
Code First
The underlying condition named in the note is sequenced before this code.
Use Additional Code
Add a second code, after this one, to fully describe the condition.
- code to identify any retained foreign body, if applicable (Z18.-)
Code Also
A second code may be needed to fully describe the condition; the note gives no sequencing direction.
- for any associated infection
Notes
General instructions on how these codes are used.
- Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code
- The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes.
7th Character
Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.
- The appropriate 7th character is to be added to each code from category S04
- Ainitial encounter
- Dsubsequent encounter
- Ssequela this code
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name S04.011S, its category, or a range that includes it.
Excludes2 1
These codes carry an Excludes2 note naming S04.011S: its condition is not part of those codes, and both may be reported when the patient has both.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Optic Nerve Disorders
The optic nerve is a bundle of more than 1 million nerve fibers that carry visual messages. You have one connecting the back of each eye (your retina) to your brain. Damage to an optic nerve can cause vision loss. The type of vision loss and how severe it is depends on where the damage occurs. It may affect one or both eyes.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert S04.011S to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About S04.011SOverview
What is the ICD-10 code for injury of optic nerve, right eye, sequela?
The ICD-10-CM code for injury of optic nerve, right eye, sequela is S04.011S (sometimes written as S04011S). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is S04.011S (Injury of optic nerve, right eye) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report injury of optic nerve, right eye, sequela on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character S in S04.011S mean?
The final character S makes this a sequela code: it reports a lingering problem that remains after the injury of optic nerve itself has resolved, not the original event.
What MS-DRG does S04.011S group to?
When injury of optic nerve, right eye, sequela is the principal diagnosis on an inpatient stay, it groups to MS-DRG 91, 92, 93, with relative weights from 0.7783 to 1.7050 depending on complications. Higher weights mean higher Medicare reimbursement.
Is S04.011S exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for injury of optic nerve, right eye, sequela on inpatient claims. The code appears in the Injuries to the head (S00-S09) range of the CMS exempt list.
