H05.019 — Cellulitis of unspecified orbit
Is H05.019 billable?
Yes, but H05.019 will trip a Medicare edit. H05.019 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists H05.019 under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
More specific alternatives
H05.019 at a glance
| Code | H05.019 |
|---|---|
| Description | Cellulitis of unspecified orbit |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to H05.019?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name H05.019 directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does H05.019 group to?
H05.019 sits in MDC 02 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 121Acute Major Eye Infections with CC/MCCmedical
- 122Acute Major Eye Infections without CC/MCCmedical
As a secondary diagnosis, H05.019 is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is H05.019 listed in the Alphabetic Index?
The Alphabetic Index lists these routes under H05.01, the nearest indexed parent of H05.019. Use them to find the family, then select the specific code.
- Cellulitis › orbit, orbital (diffuse) (phlegmonous) (septic) (suppurative)
Excludes1 — never code together — inherited from H05
The conditions below can never be reported together with H05.019 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- congenital malformation of orbit (Q10.7)
Excludes2 — not included here — inherited from Chapter 7
The conditions below are not part of H05.019, but a patient may have both at the same time. When documentation supports it, H05.019 and the excluded code may both be reported.
- 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)
Excludes2 — not included here — inherited from H00-H05
The conditions below are not part of H05.019, but a patient may have both at the same time. When documentation supports it, H05.019 and the excluded code may both be reported.
How long has H05.019 existed?
H05.019 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.