ICD-10 H49.811
Billable / Specific HCC v28: 23 CCKearns-Sayre syndrome, right eye
About ICD-10-CM H49.811
ICD-10-CM code H49.811 represents Kearns-Sayre syndrome, right eye. This is a billable/specific code in the Eye and Adnexa chapter (block H49). The 2026 edition of ICD-10-CM H49.811 became effective on October 1, 2025.
Coding Tips for H49.811
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
H49.811 is a CMS-HCC v28 risk-adjustment code (category 23). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
H49.811 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Kearns-Sayre syndrome, right eye. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for H49.811
Local Coverage Determinations (LCDs) from CMS MACs that list H49.811 as a covered diagnosis.
Showing top 3. Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing H49.811.
1 Cigna
1 Medicare
1 Aetna
CPT Codes Commonly Billed with H49.811
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert H49.811 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| H49.811 | 27787 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To H49.811
Other codes in section H49-H52 (Disorders of ocular muscles, binocular movement, accommodation and refraction).
ICD-10 H49.811, Billing FAQ
Is ICD-10 code H49.811 billable? +
Yes, H49.811 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does H49.811 affect Medicare Advantage HCC risk adjustment? +
Yes. H49.811 maps to CMS-HCC v28 category 23. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is H49.811 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does H49.811 map to? +
Per CMS GEMs, H49.811 maps to ICD-9 codes: 27787. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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