Version 2024

2024 ICD-10-CM Diagnosis Code H53.049

Amblyopia suspect, unspecified eye

ICD-10-CM Code:: H53.049
ICD-10 Code for:: Amblyopia suspect, unspecified eye
Is Billable?: Yes - Valid for Submission
Chronic Condition Indicator: ^[1]: Not chronic
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Code Information
Clinical Classification
Tabular List of Diseases and Injuries
Diagnostic Related Groups Mapping
Replacement Code
Convert to ICD-9 Code
Patient Education
Other Codes Used Similar Conditions
Code History

Code Classification

Diseases of the eye and adnexa
(H00–H59)
- Visual disturbances and blindness
  (H53-H54)
  - Visual disturbances
    (H53)

H53.049 is a billable diagnosis code used to specify a medical diagnosis of amblyopia suspect, unspecified eye. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.

Unspecified diagnosis codes like H53.049 are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.

Clinical Classification

Clinical Category is Blindness and vision defects
CCSR Category Code: EYE010
Inpatient Default CCSR: Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.
Outpatient Default CCSR: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

H53.049 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
124	OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT	02	1.3219
125	OTHER DISORDERS OF THE EYE WITHOUT MCC	02	0.7975

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Replacement Code

H53049 replaces the following previously assigned ICD-10-CM code(s):

H53.009 - Unspecified amblyopia, unspecified eye

Convert H53.049 to ICD-9-CM

ICD-9-CM Code: 368.8 - Visual disturbances NEC
Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Code History

FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018

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.