ICD-10 Code H49 – Paralytic Strabismus (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code H49 – Paralytic strabismus
What it is
H49 identifies paralytic strabismus, an eye misalignment caused by weakness or paralysis of one or more extraocular muscles. It is used when the deviation results from impaired ocular motor nerve function rather than a simple refractive or developmental issue.
Clinical signs
Common findings include diplopia, limited movement of the affected eye, and abnormal eye position that worsens in certain gaze directions. Clinical features vary; refer to documentation.
When to use this code
Use H49 when the record documents paralytic strabismus or ocular misalignment due to cranial nerve palsy or extraocular muscle paralysis. Apply it when the provider links the strabismus to a paralytic cause and does not specify a more detailed subcategory. Check documentation for laterality, associated nerve involvement, or other coded conditions.
Do not use for
Do not use this code for nonparalytic strabismus, accommodative esotropia, or transient eye deviation without documented paralysis. If the note only says “strabismus” without a paralytic cause, check documentation.
Coding tip
Code the highest level of specificity available and verify whether the provider documents the affected eye, nerve, or cause.