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H20.051

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🧬 ICD-10 CM H20.051 - Hypopyon, right eye

Short Definition

Hypopyon of the right eye — a layered accumulation of white blood cells (pus) in the inferior anterior chamber of the right eye, occurring as a manifestation of acute or subacute iridocyclitis (anterior uveitis).

Long Clinical Definition

ICD-10-CM H20.051 describes the presence of hypopyon in the right eye, specifically arising in the context of acute or subacute iridocyclitis (inflammation of the iris and ciliary body). Hypopyon is a clinical sign, not a standalone disease — it represents a layered collection of leukocytes (white blood cells) that have settled by gravity into the inferior portion of the anterior chamber, creating a visible white or cream-colored fluid level.

Hypopyon develops when the blood-aqueous barrier is sufficiently disrupted by severe ocular inflammation, infectious process, or toxic exposure, allowing massive influx of inflammatory cells into the anterior chamber. The severity of hypopyon correlates with the degree of ocular inflammation or infection.

In the ICD-10-CM classification, H20.051 falls under H20.0 Acute and subacute iridocyclitis, meaning the inflammatory process responsible for the hypopyon is acute/subacute in nature. This code is used when the cause of the iridocyclitis is not attributable to any of the listed Excludes1 systemic conditions — when it is, the associated disease-specific code takes precedence.

Anatomical and Clinical Context

Location: Right eye, anterior chamber (between cornea anteriorly and iris/lens posteriorly).

Involved structures:

  • Iris and ciliary body (primary site of inflammation in iridocyclitis).
  • Anterior chamber and aqueous humor (site of leukocyte accumulation).
  • Corneal endothelium (may show keratic precipitates, KPs).
  • Lens anterior surface (posterior synechiae may form if untreated).

Common etiologies of hypopyon-associated iridocyclitis:

  • HLA-B27-associated conditions (ankylosing spondylitis, reactive arthritis, psoriatic arthritis, IBD-related uveitis).
  • Behcet disease (classic cause of recurrent, hypopyon-forming uveitis).
  • Lens-induced uveitis (phacoantigenic uveitis).
  • Infectious anterior uveitis (bacterial, viral, fungal — though severe infectious hypopyon may shift toward endophthalmitis H44.0x).
  • Drug-induced uveitis (e.g., rifabutin, cidofovir, bisphosphonates).
  • Idiopathic acute anterior uveitis.

Key clinical features:

  • Visible layered white/cream-colored material in inferior anterior chamber.
  • Hypopyon height measured in millimeters (e.g., 1 mm, 2 mm).
  • Associated findings: ciliary flush, photophobia, pain, decreased vision, cells and flare in anterior chamber, keratic precipitates, miosis.
  • Urgent finding — warrants same-day or urgent Ophthalmology evaluation.

Official Code Structure and Tree

ICD-10-CM Code Tree

  • H00-H59 Diseases of the eye and adnexa
    • H15-H22 Disorders of sclera, cornea, iris and ciliary body
      • H20 Iridocyclitis
        • H20.0 Acute and subacute iridocyclitis
          • H20.01x Primary iridocyclitis (right, left, bilateral, unspecified)
          • H20.02x Recurrent acute iridocyclitis (right, left, bilateral, unspecified)
          • H20.03x Secondary infectious iridocyclitis (right, left, bilateral, unspecified)
          • H20.04x Secondary noninfectious iridocyclitis (right, left, bilateral, unspecified)
          • H20.05 Hypopyon
            • H20.051 - Hypopyon, right eye
            • H20.052 - Hypopyon, left eye
            • H20.053 - Hypopyon, bilateral
            • H20.059 - Hypopyon, unspecified eye
        • H20.1x Chronic iridocyclitis (right, left, bilateral, unspecified)
        • H20.2x Lens-induced iridocyclitis (right, left, bilateral, unspecified)
        • H20.8x Other iridocyclitis
        • H20.9 Unspecified iridocyclitis

Note

H20.051 is a billable, specific, lateralized ICD-10-CM code — it does not require further specificity.

Includes / Excludes / Code Also

Includes (at H20.05 level)

  • Hypopyon occurring as a manifestation of acute or subacute iridocyclitis of the right eye.
  • Layered accumulation of leukocytes in inferior anterior chamber, right eye, associated with iridocyclitis.
  • Anterior chamber reaction with visible pus level, right eye.

Excludes1 (at H20.0 level — cannot be coded with H20.051 when these are the cause)

When iridocyclitis/uveitis/iritis is documented as due to the following conditions, code from those specific sections instead:

  • Diabetes mellitus → E08-E13 with .39 suffix.
  • Diphtheria → A36.89.
  • Gonococcal infection → A54.32.
  • Herpes simplex → B00.51.
  • Herpes zoster → B02.32.
  • Late congenital syphilis → A50.39.
  • Late syphilis → A52.71.
  • Sarcoidosis → D86.83.
  • Syphilis → A51.43.
  • Toxoplasmosis → B58.09.
  • Tuberculosis → A18.54.

Code Also / Use Additional Code

  • Underlying systemic disease when documented as causally related to the iridocyclitis or hypopyon:
    • Ankylosing spondylitis → M45.-
    • Behcet disease → M35.2
    • Psoriatic arthritis → L40.5x
    • Reactive arthritis → M02.-
    • Inflammatory bowel disease → K50-K51.-

HCC / Risk Adjustment

  • HCC status:

    • H20.051 does not directly map to a CMS-HCC for risk adjustment purposes.
    • However, if the hypopyon/iridocyclitis is a manifestation of an underlying HCC-mapped systemic condition (e.g., ankylosing spondylitis, Behcet disease, IBD, diabetic uveitis), that underlying condition’s code should be coded and it may carry its own HCC weight.

  • RAF impact:

    • Code the full clinical picture: bilateral coding, underlying systemic disease, chronic vs. acute — all contribute to accurate RAF for managed care.

MS-DRG Considerations

  • H20.051 is primarily an outpatient/office-based diagnosis in the majority of cases.

  • Inpatient scenarios are uncommon but can occur when:

    • Hypopyon is severe, refractory to outpatient topical and systemic therapy.
    • Surgical intervention (anterior chamber washout, vitrectomy) is required.
    • Underlying systemic disease (e.g., Behcet with CNS involvement, sepsis with endogenous endophthalmitis) drives the inpatient admission.

  • If inpatient admission occurs with H20.051 as or near the principal diagnosis:

    • MDC 02 - Diseases & Disorders of the Eye is the typical MDC.
    • DRG selection depends on whether procedures are performed and on other diagnoses.
    • In cases of septic/infectious uveitis driving admission, the infectious disease-related DRG may dominate.

Relationship to CPT, wRVUs, and Assistant at Surgery

wRVUs

ICD-10-CM codes do not carry wRVUs. For H20.051, wRVUs are generated by:

Ophthalmological E/M / Exam Codes (most common):

CPTDescriptionNotes
92002Ophthalmological services, new patient, intermediateInitial visits, limited workup
92004Ophthalmological services, new patient, comprehensiveFirst complete exam including new uveitis workup
92012Ophthalmological services, established patient, intermediateFollow-up visits
92014Ophthalmological services, established patient, comprehensiveComprehensive uveitis monitoring visit
99213-99215Office/outpatient E/M, established patientUsed when E/M coding is chosen over eye codes
99202-99205Office/outpatient E/M, new patientNew patient medical management

Diagnostic Procedures (when performed):

CPTDescription
92250Fundus photography with interpretation
92132Anterior segment OCT scanning, unilateral
92020Gonioscopy

Procedures (if applicable)

CPTDescriptionNotes
65800Paracentesis of anterior chamberAC tap for culture and/or drainage of hypopyon
65810Paracentesis with vitreous removalMore complex tap if vitreous involved
67028Intravitreal injection of pharmacologic agentIntravitreal triamcinolone for refractory uveitis
68200Subconjunctival injectionPeriocular steroid delivery

Note

Reference the current year Medicare Physician Fee Schedule for wRVU values for each CPT.

Assistant at Surgery

  • H20.051 is primarily managed medically (topical and systemic corticosteroids, cycloplegics, immunosuppressants).
  • Surgical intervention is uncommon but, when indicated:
    • 65800 (anterior chamber paracentesis) — typically a single-surgeon procedure; assistant-at-surgery rarely applicable.
    • 67028 (intravitreal injection) — single-surgeon procedure; assistant-at-surgery not applicable.
    • Check the MPFS assistant-at-surgery indicator for any specific CPT used.

Coding Examples

Example 1 - New Patient, Acute Hypopyon, Idiopathic Iridocyclitis

Scenario: 32-year-old presents to ophthalmology as a new patient with 2-day history of right eye pain, photophobia, and blurred vision. Slit-lamp exam shows 2+ cell, 2+ flare, 1 mm hypopyon in inferior anterior chamber, right eye. IOP right eye 28 mmHg. No systemic disease identified. Treated with topical prednisolone and cyclopentolate.

ICD-10-CM:

  • H20.051 - Hypopyon, right eye.
  • H40.011x - Open-angle glaucoma suspect, right eye (if IOP elevation requires attention).

CPT:

  • 92004 - Ophthalmological services, new patient, comprehensive.

Example 2 - Established Patient with HLA-B27 Positive Recurrent Uveitis and Hypopyon

Scenario: 45-year-old with known ankylosing spondylitis and HLA-B27-positive uveitis, established patient, presents with recurrence of right eye pain and photophobia. Slit-lamp shows hypopyon 0.5 mm right eye, KPs, posterior synechiae forming. Patient increased topical steroids.

ICD-10-CM:

  • H20.051 - Hypopyon, right eye.
  • M45.9 - Ankylosing spondylitis of unspecified sites in spine (underlying systemic cause).

CPT:

  • 92014 - Ophthalmological services, established patient, comprehensive.

Example 3 - Urgent Visit with Anterior Chamber Tap

Scenario: 28-year-old with Behcet disease presents with severe recurrent right eye hypopyon (2 mm), significantly decreased vision OD. Decision made to perform anterior chamber tap for culture and injection.

ICD-10-CM:

  • H20.051 - Hypopyon, right eye.
  • M35.2 - Behcet disease (underlying systemic etiology).

CPT:

  • 65800 - Paracentesis of anterior chamber of eye.
  • 92014 - Ophthalmological services, established patient, comprehensive.
    • Consider modifier -25 on the E/M if billing both on the same day and payer requires it.

Example 4 - Follow-Up for Healing Hypopyon (Resolved)

Scenario: Same patient, 1 week later. Hypopyon has resolved, trace cells remain. Continue on tapering prednisolone.

ICD-10-CM:

  • H20.011 - Primary iridocyclitis, right eye (if hypopyon has resolved, no longer appropriate to assign H20.051 — revert to the primary iridocyclitis code at the H20.01x level).
  • M35.2 - Behcet disease.

CPT:

  • 92012 - Ophthalmological services, established patient, intermediate.

Key Coding Pearls

  • H20.051 is specifically for hypopyon — the visible layered accumulation of WBCs in the anterior chamber. Once hypopyon resolves, the code should transition to the appropriate H20.0x acute iridocyclitis sub-code without hypopyon.

  • Laterality is required. Never default to H20.059 (unspecified) when the provider clearly documents which eye is affected.

  • Excludes1 is strict — if a documented systemic cause (herpes, TB, sarcoidosis, etc.) is the etiology of the iridocyclitis, do not use H20.051. The disease-specific code from that system’s chapter replaces it.

  • Code underlying systemic disease whenever it is documented as related — this is especially important for risk adjustment, clinical documentation integrity, and the care coordination/coding completeness picture.

  • Endophthalmitis differentiation — a hypopyon caused by bacterial endophthalmitis should be coded under H44.0x (purulent endophthalmitis), not H20.051. Clarify the clinical diagnosis with the provider when documentation is ambiguous.

Look Here:

Typical CPT Pairings: Office E/M and Eye Codes: - Code: “92012” description: “Ophthalmological services, medical examination and evaluation, established patient — intermediate service” - Code: “92014” description: “Ophthalmological services, medical examination and evaluation, established patient — comprehensive service” - Code: “92002” description: “Ophthalmological services, medical examination and evaluation, new patient — intermediate service” - Code: “92004” description: “Ophthalmological services, medical examination and evaluation, new patient — comprehensive service” - Code: “99213-99215” description: “Office/outpatient E/M — some ophthalmologists use E/M codes rather than 92xxx codes depending on service type and payer”

Diagnostic Procedures: - Code: “92250” description: “Fundus photography with interpretation and report — to document posterior segment findings if uveitis has extended posteriorly” - Code: “92132” description: “Scanning computerized ophthalmic diagnostic imaging, anterior segment (OCT anterior segment) — if used to measure hypopyon layer or assess anterior segment anatomy” - Code: “92020” description: “Gonioscopy — to evaluate anterior chamber angle and peripheral anterior synechiae” - Code: “92060” description: “Sensorimotor examination — rarely applicable, but if motility affected”

Procedures. if applicable: - Code: “65800” description: “Paracentesis of anterior chamber of eye (separate procedure) — for anterior chamber tap to culture/drain hypopyon” - Code: “65810” description: “Paracentesis of anterior chamber of eye, with removal of vitreous and/or discission of anterior hyaloid membrane, with or without air injection” - Code: “67028” description: “Intravitreal injection of pharmacologic agent — if intravitreal corticosteroid (e.g., triamcinolone) is used for refractory uveitis” - Code: “68200” description: “Subconjunctival injection — occasionally used for periocular corticosteroid delivery”

Tip

Code Also:

  • “Underlying systemic condition when Iridocyclitis/hypopyon is caused by or associated with a documented systemic disease (e.g., ankylosing spondylitis M45.-, HLA-B27-associated conditions, sarcoidosis D86.-, Behcet disease M35.2)”

Info

Assistant at Surgery Payable:

  • Notes “Depends on CPT code for any associated ocular procedure. Most in-office management of hypopyon/uveitis is medical (topical/systemic steroids, cycloplegics). If an anterior chamber tap, washout, or intravitreal injection is performed, check the individual CPT’s MPFS assistant-at-surgery indicator.”

Info

wRVU Relevance:

  • notes “ICD-10-CM codes do not carry wRVUs. wRVUs are assigned to CPT service codes. For H20.051, the wRVU is generated by the ophthalmology E/M or eye exam code used (92012, 92014, 99213-99215) plus any applicable procedure codes (65800, 67028, etc.). Reference the current MPFS for specific wRVU values.”

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