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H02.429

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🧬ICD-10 H02.42 - Myogenic Ptosis of Eyelid, Unspecified

Quick Reference Table

ElementValue
ICD-10 CodeH02.429
DescriptionMyogenic ptosis of eyelid
Billable✗ No (family/header code - use child codes)
Parent CategoryH02.4 - Ptosis of eyelid
ChapterVII - Diseases of the eye and adnexa (H00-H59)
Laterality Child CodesH02.421 (right), H02.422 (left), H02.423 (bilateral), H02.429 (unspecified)
MechanismPrimary weakness of levator palpebrae superioris and/or Müller’s muscle
Common EtiologiesOcular myasthenia gravis, CPEO, muscular dystrophies, myotonic dystrophy
Key Exam FindingReduced levator function (<10-12 mm), often fatigable
HCC StatusNo (non-HCC family)
Excludes1Congenital eyelid malformations (Q10.0-Q10.3)

Short Definition

H02.429 is a billable code** for myogenic ptosis of eyelid, unspecified eyelid - drooping of the upper and/or eyelid(s) caused by primary dysfunction or weakness of the levator palpebrae superioris muscle (and/or Müller’s smooth muscle). Always use laterality-specific child codes (H02.421-H02.429) for billing but try to avoid having to use H02.429.

Full Description

What H02.429 Represents

H02.429 is the header category for myogenic ptosis, one of four major ptosis subtypes in ICD-10-CM:

  • H02.40 - Unspecified ptosis
  • H02.41 - Mechanical ptosis
  • H02.42 - Myogenic ptosis
  • H02.43 - Paralytic ptosis

Myogenic ptosis = ptosis where the primary pathology is in the eyelid elevator muscle(s), not:

  • Nerve supply (paralytic).
  • Aponeurosis/tendon (involutional/aponeurotic).
  • External mechanical forces (mechanical).

Child Codes (Billable):

  • H02.421 - Myogenic ptosis of right eyelid
  • H02.422 - Myogenic ptosis of left eyelid
  • H02.423 - Myogenic ptosis of bilateral eyelids
  • H02.429 - Myogenic ptosis of unspecified eyelid (avoid if possible)

Etiologies & Pathophysiology

Common Causes of Myogenic Ptosis:

  1. Ocular Myasthenia Gravis (most common neuromuscular):

    • Autoimmune attack on neuromuscular junction of levator/Müller’s muscle.
    • Fatigable ptosis - worsens with sustained upgaze or end-of-day.
    • Ice pack test positive (improvement with cold).

  2. Chronic Progressive External Ophthalmoplegia (CPEO):

    • Mitochondrial myopathy affecting extraocular muscles and levators.
    • Bilateral symmetric ptosis with ophthalmoparesis, ptosis first sign.

  3. Muscular Dystrophies:

    • Myotonic dystrophy (most common adult muscular dystrophy with ptosis).
    • Oculopharyngeal muscular dystrophy.
    • Limb-girdle muscular dystrophies.

  4. Myopathic Levator Dysfunction:

    • Idiopathic/age-related levator muscle degeneration.
    • Post-radiation or inflammatory myopathy.

  5. Congenital Myogenic Ptosis (but coded under Q10.x due to Excludes1).

Pathophysiology: Degeneration, fibrosis, or neuromuscular failure in levator palpebrae superioris (main elevator) and/or Müller’s muscle (smooth muscle, sympathetic innervation).

Clinical Features

Symptoms:

  • Progressive drooping of upper eyelid(s).
  • Visual field obstruction (superior).
  • Brow ache, chin-up posture.
  • Fatigability in neuromuscular causes (worse evening).

Exam Findings:

  • Reduced levator function (<10-12 mm excursion).
  • Low MRD1 (<2.5-3 mm).
  • Poor Bell’s phenomenon in CPEO.
  • Fatigability test positive in myasthenia (sustained upgaze worsens ptosis).

Coding Specifics

Child Code Breakdown

CodeDescriptionLaterality
H02.42Myogenic ptosis of eyelidNon-billable family/header
H02.421Myogenic ptosis of right eyelidRight (OD)
H02.422Myogenic ptosis of left eyelidLeft (OS)
H02.423Myogenic ptosis of bilateral eyelidsBilateral (OU)
H02.429Myogenic ptosis of unspecified eyelidUnspecified (avoid)

Always code to laterality - H02.429 alone will be rejected as non-billable.

When to Use H02.42 Family

Use child codes when:

  • Provider documents “myogenic ptosis” or clearly describes levator muscle weakness.
  • Underlying condition supports muscle etiology (MG, CPEO, muscular dystrophy).
  • Normal aponeurosis and no mechanical obstruction.

Do NOT use H02.429 family when:

  • Mechanical (dermatochalasis, mass) → H02.41x.
  • Paralytic (CN III palsy) → H02.43x.
  • Unspecified mechanism → H02.40x.
  • Congenital → Q10.0-Q10.3 (Excludes1).
CategoryExample CodesNotes
Mechanical PtosisH02.411-H02.419Dermatochalasis, edema, masses
Paralytic PtosisH02.431-H02.439Neurogenic (CN III, Horner)
Unspecified PtosisH02.401-H02.409Mechanism not documented
Underlying DiseasesG70.00 (myasthenia), G71.3 (mitochondrial), G71.0 (muscular dystrophy)Code these too for complete picture

HCC Status

  • H02.429 family is NOT HCC-weighted.
  • Ptosis is local, not systemic chronic disease.
  • Underlying conditions (e.g., myasthenia gravis G70.x - HCC 84; muscular dystrophy G71.0 - HCC 87) may carry HCC weight.
  • H02.42x role: Supports functional surgery billing, not risk adjustment.

Documentation Requirements

Essential Provider Documentation

  1. “Myogenic ptosis” explicitly stated.
  2. Laterality (right/left/bilateral).
  3. Levator function measurement (reduced).
  4. Underlying etiology (MG, CPEO, etc.).
  5. Functional impact (visual fields, symptoms).
  6. Distinction from mechanical/paralytic.

Sample Phrases:

  • “Myogenic ptosis OU due to mitochondrial CPEO.”
  • “Left myogenic ptosis with fatigability consistent with ocular MG.”

Audit Red Flags

  • H02.42x billed without laterality → rejected.
  • “Ptosis” alone → should be unspecified H02.40x.
  • Mechanical findings (normal levator, heavy skin) coded as myogenic.

Associated CPT Codes

Diagnostics

CPTDescriptionUse
92081-92083Visual fieldsSuperior field loss documentation
92285External photosPre-op ptosis position
95885EMG nerve stimulationMyasthenia workup
92133OCT (if needed)Rule out optic neuropathy

Surgery (Functional Ptosis Repair)

CPTDescriptionNotes
67901-67909Ptosis repair (levator resection, frontalis sling)For myogenic ptosis
15822-15823BlepharoplastyIf dermatochalasis coexists

Sample Coding Scenario

Assessment: Bilateral myogenic ptosis due to myotonic dystrophy type 1.

ICD-10:

  • H02.423 - Myogenic ptosis of bilateral eyelids
  • G71.11 - Myotonic muscular dystrophy

CPT: 92083 (VF), 99214 (visit)

References

[1] ICD-10-CM structure showing H02.42 as non-billable family for myogenic ptosis with child codes H02.421-H02.429.[web:932][web:939]
[2] AAPC descriptions of H02.42 - Myogenic ptosis of eyelid and laterality requirements.[web:932][web:937]
[3] Additional code compendia confirming H02.42 non-billable status and child code mapping.[web:930][web:931]
[4] Ptosis classification including myogenic subtype, exam findings, and etiologies like MG/CPEO.[web:831][web:924]
[5] Clinical differentiation of ptosis types (myogenic vs mechanical vs paralytic).[web:928]
[6] Ocular myasthenia and CPEO as primary myogenic ptosis causes.[web:924][web:926]
[7] Muscular dystrophies and progressive ophthalmoplegia with myogenic ptosis.[web:926]
[8] Coding references for H02.4 ptosis family and Excludes1 for congenital Q10.x.[web:843]
[9] HCC mapping notes (none for H02.42x, but potential for underlying G70/G71 codes).[web:855]

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