H46.00 — Optic papillitis, unspecified eye
Is H46.00 billable?
Yes, but H46.00 will trip a Medicare edit. H46.00 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists H46.00 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
H46.00 at a glance
| Code | H46.00 |
|---|---|
| Description | Optic papillitis, unspecified eye |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to H46.00?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name H46.00 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 H46.00 group to?
H46.00 sits in MDC 02 and helps define the logic of 1 MS-DRG (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 123Neurological Eye Disordersmedical
As a secondary diagnosis, H46.00 is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is H46.00 listed in the Alphabetic Index?
These are the routes through the Alphabetic Index that lead to H46.00. They show the wording a clinician may have documented, which often differs from the Tabular description.
- Papillitis
Excludes2 — not included here — inherited from Chapter 7
The conditions below are not part of H46.00, but a patient may have both at the same time. When documentation supports it, H46.00 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 H46
The conditions below are not part of H46.00, but a patient may have both at the same time. When documentation supports it, H46.00 and the excluded code may both be reported.
How long has H46.00 existed?
H46.00 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.