ICD-10 Code H49.33 – Total (external) ophthalmoplegia, bilateral (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code H49.33 – Total (external) ophthalmoplegia, bilateral
What it is
H49.33 identifies complete paralysis of the external eye muscles in both eyes. Use this code when documentation states total bilateral ophthalmoplegia affecting eye movement.
Clinical signs
Typical findings include marked limitation or absence of voluntary eye movements in both eyes. Diplopia, ptosis, or associated neurologic findings may be present; clinical features vary, so refer to documentation.
When to use this code
Use H49.33 when the provider documents total external ophthalmoplegia on both sides, whether as a primary diagnosis or a confirmed finding. It may appear in neurologic, neuromuscular, or ophthalmic evaluations. If the record only says ophthalmoplegia without laterality or completeness, check documentation.
Do not use for
Do not use this code for unilateral ophthalmoplegia or for partial eye movement restriction. Also avoid it when the note describes a different cranial nerve palsy or nonspecific diplopia without confirmed bilateral total ophthalmoplegia.
Coding tip
Confirm both laterality and “total” involvement in the provider note before assigning H49.33.