H59.219 — Accidental puncture and laceration of unspecified eye and adnexa during an ophthalmic procedure
Is H59.219 billable?
Yes, but H59.219 will trip a Medicare edit. H59.219 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists H59.219 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
H59.219 at a glance
| Code | H59.219 |
|---|---|
| Description | Accidental puncture and laceration of unspecified eye and adnexa during an ophthalmic procedure |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to H59.219?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name H59.219 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 H59.219 group to?
H59.219 sits in MDC 15 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.
- 791Prematurity with Major Problemsmedical
As a secondary diagnosis, H59.219 is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is H59.219 listed in the Alphabetic Index?
The Alphabetic Index lists these routes under H59.21, the nearest indexed parent of H59.219. Use them to find the family, then select the specific code.
- Complication › intraoperative › puncture or laceration › eye and adnexa › during ophthalmic procedure (s) (from) (of)
Excludes1 — never code together — inherited from H59
The conditions below can never be reported together with H59.219 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
Excludes2 — not included here — inherited from Chapter 7
The conditions below are not part of H59.219, but a patient may have both at the same time. When documentation supports it, H59.219 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)
How long has H59.219 existed?
H59.219 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.