H57.09 — Other anomalies of pupillary function
H57.09 is a billable, specific ICD-10-CM code for other anomalies of pupillary function. It is valid for submission on a claim.
Risk adjustment
H57.09 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
H57.09 is named in 8 Medicare coverage policies — 8 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56453Billing and Coding: Cataract Extraction
- A56544Billing and Coding: Cataract Extraction
- A56615Billing and Coding: Cataract Extraction (including Complex Cataract Surgery)
- A56729Billing and Coding: Magnetic Resonance Imaging of the Head and Neck
How H57.09 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to H57.09.
- Hippus
- Iridoplegia(complete) (partial) (reflex)
- Argyll Robertson phenomenon, pupil or syndrome›atypical
- Argyll Robertson phenomenon, pupil or syndrome›nonsyphilitic
- Paralysis, paralytic›iris
- Anomaly, anomalous›pupil›function›specified type NEC
Related codes at this level
Codes that share H57.0. If H57.09 is not quite right, the correct code is usually one of these.
Questions about H57.09
- Is H57.09 a billable ICD-10-CM code?
- Yes. H57.09 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does H57.09 sit in the tabular list?
- Diseases of the eye and adnexa (H00-H59), in the block Other disorders of eye and adnexa (H55-H57).