H02.432

🧬 ICD-10 H02.432 - Paralytic Ptosis of Left Eyelid

Quick reference

Element	Value
ICD-10-CM code	H02.432
Official descriptor	Paralytic ptosis of left eyelid
Parent category	H02.43 - Paralytic ptosis of eyelid (aka “neurogenic ptosis of eyelid”)
ICD-10-CM chapter / block	Eye & adnexa → H00-H05 (eyelid/lacrimal/orbit disorders)
Laterality	Left eyelid (OS)
Billable	Yes (laterality-specific code)
Excludes1	Congenital malformations of eyelid (Q10.0-Q10.3)
Typical clinical meaning	Eyelid droop due to impaired neural input (CN III and/or sympathetic pathway)
Common payer relevance	Appears in CMS “Billing and Coding” articles for functional eyelid surgery and visual field testing indications

Short description

H02.432 codes paralytic (neurogenic) ptosis of the left eyelid, meaning left upper lid droop attributable to a nerve pathway problem rather than excess tissue weight (mechanical) or primary muscle disease (myogenic).

Use it when the provider documents paralytic/neurogenic ptosis and specifies the left eyelid.

Full description

Ptosis is drooping of the upper eyelid that can reduce the vertical palpebral fissure height and may obstruct the visual axis. Neurogenic (paralytic) ptosis occurs when eyelid elevation is reduced because the neural drive to eyelid elevators is disrupted (classically CN III to the levator palpebrae superioris and/or sympathetic innervation to Müller’s muscle).

Clinical patterns you’ll see documented in paralytic ptosis include:

• Oculomotor (CN III) palsy-related ptosis, which can be associated with abnormal pupil findings when due to compressive lesions such as tumor or aneurysm (documentation often drives urgent imaging decisions).
• Horner syndrome, where ptosis is typically mild (often ≤2 mm) and associated with miosis and sometimes anhidrosis, reflecting sympathetic pathway disruption affecting Müller’s muscle.

Note

Because H02.432 is “paralytic ptosis,” the encounter note should make the neurogenic mechanism explicit (or strongly implied by diagnosis language such as “third nerve palsy” or “Horner syndrome”), rather than simply stating “ptosis OS.”

Coding guidance (coder-facing)

Use H02.432 when

• The provider documents paralytic ptosis (or “neurogenic ptosis”) of the left eyelid.
• The documentation links the ptosis to a neurogenic cause (examples: CN III palsy, Horner syndrome, post-traumatic neurogenic ptosis).

Do not use H02.432 when

• Ptosis is documented but mechanism is not specified → use the “unspecified ptosis” laterality code instead (H02.402 for left eyelid) rather than paralytic.
• Ptosis is clearly mechanical (e.g., dermatochalasis, tumor weight, edema, scarring) → mechanical ptosis codes (H02.41x) are the better fit than paralytic.
• Ptosis is clearly myogenic (levator muscle weakness or neuromuscular junction fatigue pattern documented as myogenic) → myogenic ptosis codes (H02.42x) apply instead of paralytic.
• Ptosis is congenital → Excludes1 indicates congenital eyelid malformations (Q10.0-Q10.3) should be used rather than H02.43x.

Code neighbors (useful in audits/queries)

Code	Description	Notes
H02.43	Paralytic ptosis of eyelid (category)	Parent category listing child codes
H02.432	Paralytic ptosis of left eyelid	This note
H02.431	Paralytic ptosis of right eyelid	Same condition, right side
H02.433	Paralytic ptosis of bilateral eyelids	Both sides
H02.439	Paralytic ptosis, unspecified eyelid	Avoid if laterality exists

HCC information (what you can safely document)

CMS coverage/billing articles list H02.432 among diagnosis codes relevant to certain services (e.g., blepharoplasty/blepharoptosis repair and visual field testing), but these articles do not provide CMS-HCC mapping status.

Note

If your workflow requires risk adjustment confirmation, verify H02.432 against your organization’s current CMS-HCC mapping file (since HCC status is model- and year-specific and isn’t stated in the sources above).

Documentation checklist (work-ready)

Minimum elements to support H02.432

• Laterality: Explicitly “left upper eyelid” / “OS.”
• Mechanism language: “Paralytic ptosis,” “neurogenic ptosis,” “ptosis due to CN III palsy,” or “ptosis due to Horner syndrome.”
• Neuro exam basics that usually appear in good notes: Pupils and extraocular movements documented, because CN III palsy and Horner patterns are commonly discussed in neurogenic ptosis evaluation.
• Functional impact (especially if surgery is contemplated): Superior visual field obstruction, driving/reading difficulty, brow fatigue, chin-up posture.
• Objective measurements when available: MRD1 and levator function measurements are common in ptosis workups.
• Congenital vs acquired statement: Avoid congenital wording unless it’s truly congenital (Excludes1).

“Query the provider” triggers

• “Ptosis OS” documented with no etiology/mechanism, but coder selected H02.432 → query for whether it is paralytic vs mechanical vs myogenic vs unspecified.
• “Horner syndrome” or “third nerve palsy” appears elsewhere in the chart, but assessment only says “ptosis” → query to explicitly document “paralytic/neurogenic ptosis.”
• Congenital history (“since birth”) paired with H02.432 → query and correct to Q10.x due to Excludes1 conflict.

Medical-necessity packet (common payer/CMS pattern)

CMS “Billing and Coding” articles for eyelid surgery and visual field testing commonly appear in preauth/coverage workflows where diagnoses like H02.432 support the indication.
For functional pathways, charts commonly include documented functional complaints plus objective testing such as visual fields and external photographs (payer rules vary by MAC/plan).

Common CPT pairings + sample note

CPT codes you’ll commonly see with paralytic ptosis workups

• E/M (examples): 99202-99205 (new), 99212-99215 (established), depending on setting and documentation.
• Visual field testing: 92081-92083 are commonly used in ptosis/visual obstruction evaluations and appear in CMS visual field billing/coding contexts where ptosis diagnoses are listed.
• External ocular photography: 92285 is frequently used in eyelid surgery documentation workflows (often requested by payers for preauthorization).
• Imaging (when neurogenic cause is being evaluated): CT/MRI head/orbit may be ordered, and CMS has billing/coding articles that list H02.432 among diagnoses associated with head/neck imaging contexts.

Surgical CPT context (if functional correction pursued)

CMS blepharoplasty/blepharoptosis repair billing/coding articles include H02.432 among diagnosis codes that may be used in claims contexts for eyelid surgery when coverage criteria are met.

Sample documentation (clinic note - adaptable)

CC: Drooping left upper eyelid.

HPI: Adult patient with acquired, progressive left upper eyelid droop and superior visual field interference. Denies trauma. No eye pain. Reports brow strain and needing to raise eyebrows to see.

Exam: Ptosis OS. Pupils and extraocular movements documented to evaluate for neurogenic patterns such as CN III palsy and Horner syndrome. MRD1/levator function recorded if available as part of ptosis characterization.

Assessment: Paralytic (neurogenic) ptosis of left eyelid. Differential includes CN III palsy vs Horner syndrome (document supporting signs, including pupil findings when applicable).

Plan: Neuro workup and imaging if clinically indicated based on presentation; document functional limitations and consider visual field testing and external photos if pursuing functional ptosis repair pathway.

ICD-10-CM: H02.432
CPT (examples): 99214, 92083, 92285 (as performed/appropriate).

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Source map (intentionally “obscure” mix)

• Code definition & laterality: AAPC + Unbound Medicine + ECGWaves.
• Category structure + Excludes1 list: AAPC H02.43 page.
• Neurogenic ptosis clinical patterns (CN III palsy, Horner): Ptosis (eyelid) clinical discussion.
• CMS billing/coding context (surgery, visual fields, imaging): CMS MCD articles listing H02.432.