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    v1.0.28
    OpenPayerBilling CodesDisorders of ocular muscles, binocular movement, accommodation and refractionICD-10-CM h49-paralytic-strabismus
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    ICD-10-CM Code For Paralytic Strabismus: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group H49 includes diagnoses for paralytic strabismus caused by paresis or paralysis of extraocular muscles, such as third, fourth, or sixth cranial nerve palsies and other specified muscle paralyses affecting ocular alignment. These ICD-10-CM diagnosis codes are used to document clinical presentations of ocular motility impairment, diplopia, and the underlying neurologic or traumatic causes, capturing disease severity and involvement of specific muscles or nerves. Accurate coding within the ICD-10-CM H49 group supports proper claim adjudication by payers, complete clinical documentation, and appropriate reimbursement.

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    ICD-10-CM H49: Paralytic Strabismus Overview

    The ICD-10-CM H49 group represents paralytic strabismus, a set of diagnoses involving weakness or paralysis of extraocular muscles leading to misalignment of the visual axes. These conditions affect ocular motility and binocular vision and can result from nerve palsies, trauma, or systemic disease. Accurate coding matters because it documents clinical complexity and supports appropriate reimbursement decisions.

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    When to Use

    Use a code from this group when a patient presents with documented weakness or paralysis of extraocular muscles causing strabismus, diplopia, or impaired ocular alignment. Select the code that specifies the affected muscle or cranial nerve and any laterality or secondary causes when documented.

    ICD-10-CM Codes

    29 rows

    ICD-10-CM CodeDescription
    H49.00Third [oculomotor] nerve palsy, unspecified eye
    H49.01Third [oculomotor] nerve palsy, right eye
    H49.02Third [oculomotor] nerve palsy, left eye
    H49.03Third [oculomotor] nerve palsy, bilateral
    H49.10Fourth [trochlear] nerve palsy, unspecified eye
    H49.11Fourth [trochlear] nerve palsy, right eye
    H49.12Fourth [trochlear] nerve palsy, left eye
    H49.13Fourth [trochlear] nerve palsy, bilateral
    H49.20Sixth [abducent] nerve palsy, unspecified eye
    H49.21Sixth [abducent] nerve palsy, right eye
    H49.22Sixth [abducent] nerve palsy, left eye
    H49.23Sixth [abducent] nerve palsy, bilateral
    H49.30Total (external) ophthalmoplegia, unspecified eye
    H49.31Total (external) ophthalmoplegia, right eye
    H49.32Total (external) ophthalmoplegia, left eye
    H49.33Total (external) ophthalmoplegia, bilateral
    H49.40Progressive external ophthalmoplegia, unspecified eye
    H49.41Progressive external ophthalmoplegia, right eye
    H49.42Progressive external ophthalmoplegia, left eye
    H49.43Progressive external ophthalmoplegia, bilateral

    Showing 1–20 of 29

    DRG Codes

    2 rows

    DRG CodeDescription
    123Neurological Eye Disorders
    642Inborn and Other Disorders of Metabolism

    Typical Clinical Scenarios

    • An elderly patient presents to the emergency department with sudden onset double vision and difficulty moving the affected eye after an ischemic stroke. Examination shows an isolated palsy of the lateral rectus with impaired abduction of the eye consistent with a sixth cranial nerve palsy; imaging confirms recent infarct in the brainstem. A code from this group is assigned to capture the paralytic strabismus as an acute cranial nerve palsy related to the cerebrovascular event. Typical codes: H49.22, H49.23
    • A middle-aged patient in outpatient neuro-ophthalmology follows for chronic diplopia and long-standing limitation of upgaze after traumatic injury to the eye muscles two years prior; symptoms are stable but cause persistent binocular dysfunction. On exam there is a chronic paralytic restriction of the superior rectus/levator complex with compensatory head tilt and need for prism or surgical planning. A diagnosis from this group is used to document the chronic paralytic strabismus and guide management decisions. Typical codes: H49.12, H49.13
    • A young adult with multiple sclerosis is admitted for worsening neurologic symptoms and reports new binocular horizontal diplopia and gaze palsy developing over days. Neurologic exam demonstrates bilateral limitation of lateral gaze with bilateral involvement of the abducens nerves, consistent with paralytic strabismus as a neurologic complication of demyelinating disease; the ocular motility disorder is coded to capture the complication/comorbidity. Typical codes: H49.811, H49.812, H49.819

    Related Codes

    H50-OTHER-STRABISMUS

    ICD-10-CM Code For Other Strabismus: Group Overview

    H51-OTHER-DISORDERS-OF-BINOCULAR-MOVEMENT

    ICD-10-CM Code For Other Disorders Of Binocular Movement: Group Overview

    H52-DISORDERS-OF-REFRACTION-AND-ACCOMMODATION

    ICD-10-CM Code For Disorders Of Refraction And Accommodation: Group Overview

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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