H49.819 — Kearns-Sayre syndrome, unspecified eye
Is H49.819 billable?
Yes, but H49.819 will trip a Medicare edit. H49.819 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists H49.819 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.
H49.819 at a glance
| Code | H49.819 |
|---|---|
| Description | Kearns-Sayre syndrome, unspecified eye |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to H49.819?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name H49.819 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 H49.819 group to?
H49.819 sits in MDC 10 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.
- 642Inborn and Other Disorders of Metabolismmedical
As a secondary diagnosis, H49.819 is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is H49.819 listed in the Alphabetic Index?
The Alphabetic Index lists these routes under H49.81, the nearest indexed parent of H49.819. Use them to find the family, then select the specific code.
- Kearns-Sayre syndrome
- Strabismus › paralytic › Kearns-Sayre syndrome (congenital) (nonparalytic)
- Strabismus › paralytic › ophthalmoplegia › progressive › with pigmentary retinopathy (congenital) (nonparalytic)
Excludes2 — not included here — inherited from Chapter 7
The conditions below are not part of H49.819, but a patient may have both at the same time. When documentation supports it, H49.819 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 H49-H52
The conditions below are not part of H49.819, but a patient may have both at the same time. When documentation supports it, H49.819 and the excluded code may both be reported.
- nystagmus and other irregular eye movements (H55)
Excludes2 — not included here — inherited from H49
The conditions below are not part of H49.819, but a patient may have both at the same time. When documentation supports it, H49.819 and the excluded code may both be reported.
Code also — inherited from H49.81
Two codes may be needed to describe the condition fully. Whether H49.819 is sequenced first depends on the reason for the encounter.
- , if applicable, other manifestations, such as:
- heart block (I45.9)
How long has H49.819 existed?
H49.819 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.