ICD-10 H53.131
Billable / Specific CCSudden visual loss, right eye
About ICD-10-CM H53.131
ICD-10-CM code H53.131 represents Sudden visual loss, right eye. This is a billable/specific code in the Eye and Adnexa chapter (block H53). The 2026 edition of ICD-10-CM H53.131 became effective on October 1, 2025.
Coding Tips for H53.131
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
H53.131 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.
Inpatient DRG Impact, CC
codes Sudden visual loss, right eye. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for H53.131
Local Coverage Determinations (LCDs) from CMS MACs that list H53.131 as a covered diagnosis.
Showing top 10 of 258 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing H53.131.
2 Cigna
5 Medicare
CPT Codes Commonly Billed with H53.131
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
Convert H53.131 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 |
|---|---|---|
| H53.131 | 36811 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To H53.131
Other codes in section H53-H54 (Visual disturbances and blindness).
ICD-10 H53.131, Billing FAQ
Is ICD-10 code H53.131 billable? +
Yes, H53.131 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is H53.131 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 CPT codes are commonly billed with H53.131? +
Procedures frequently paired with H53.131 include: 70473, 70472.
What ICD-9 codes does H53.131 map to? +
Per CMS GEMs, H53.131 maps to ICD-9 codes: 36811. 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 July 16, 2026.
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