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H44.001

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H44.001 - Unspecified Purulent Endophthalmitis, Right Eye

Code Classification

  • ICD-10-CM Code: H44.001
  • Short Description: Unspecified purulent endophthalmitis, right eye
  • Long Description: Unspecified purulent endophthalmitis, right eye
  • Chapter: H (H00-H59) - Diseases of the eye and adnexa
  • Block: H43-H44 - Disorders of vitreous body and globe
  • Category: H44 - Disorders of globe
  • Subcategory: H44.0 - Purulent endophthalmitis
  • Laterality: Right eye (1 = right, 2 = left, 3 = bilateral, 9 = unspecified)

Clinical Description

Purulent endophthalmitis is a severe, sight-threatening intraocular infection characterized by inflammation of the internal structures of the eye with purulent (pus-containing) exudate. This represents a medical and surgical emergency requiring immediate intervention to preserve vision and prevent loss of the eye.

Pathophysiology

Endophthalmitis results from infectious microorganisms gaining access to the normally sterile intraocular compartments (aqueous and vitreous chambers), leading to:

  • Intense inflammatory response with neutrophil infiltration
  • Purulent exudate formation in vitreous cavity
  • Destruction of intraocular structures
  • Potential for permanent vision loss or globe loss if untreated

Etiologies

Exogenous (most common):

  • Postoperative (60-70% of cases):
    • Following cataract surgery (most common, 0.1-0.3% incidence)
    • Following vitrectomy, glaucoma surgery, corneal transplant
    • Typically presents within days to weeks post-surgery
  • Post-traumatic (20-30% of cases):
    • Penetrating ocular trauma with or without retained foreign body
    • Open globe injuries
  • Intravitreal injection-related:
    • Following anti-VEGF injections (rare, ~0.05% incidence)

Endogenous (hematogenous):

  • Bacteremia or fungemia with seeding to eye
  • Common sources: endocarditis, UTI, line infections, IV drug use
  • More common in immunocompromised patients
  • Accounts for ~5-10% of cases

Causative Organisms

Bacterial (most common):

  • Gram-positive (70-90%):
    • Staphylococcus epidermidis (most common postoperative)
    • Staphylococcus aureus (more virulent, post-traumatic)
    • Streptococcus species
    • Enterococcus species
  • Gram-negative (10-20%):
    • Pseudomonas aeruginosa (highly virulent)
    • Haemophilus influenzae
    • Enterobacteriaceae

Fungal:

  • Candida species (most common fungal)
  • Aspergillus species
  • More common in endogenous cases or post-trauma

Clinical Presentation

Symptoms:

  • Rapid onset of decreased vision (hours to days)
  • Severe ocular pain
  • Photophobia
  • Red eye
  • Floaters or increased “spots” in vision
  • Periocular swelling

Signs:

  • Decreased visual acuity (can range from mild to light perception only)
  • Hypopyon (layered white blood cells in anterior chamber) - hallmark sign
  • Vitreous infiltrates/haze/opacity (obscures view of retina)
  • Anterior chamber reaction (cells and flare)
  • Corneal edema
  • Conjunctival chemosis and injection
  • Lid edema
  • Relative afferent pupillary defect (RAPD) in severe cases
  • Retinal vasculitis, hemorrhages (in severe cases)

Severity Classification

Based on Endophthalmitis Vitrectomy Study (EVS) criteria:

  • Visual acuity at presentation:
    • Better than hand motions: Generally better prognosis
    • Hand motions or worse: Higher risk for poor visual outcome
    • Light perception only: Very poor prognosis

Significance

  • Vision-threatening emergency: Requires treatment within hours
  • High morbidity: 25-50% have final vision worse than 20/200
  • Risk of globe loss: 5-10% require enucleation/evisceration
  • Permanent visual impairment: Common even with treatment
  • Legal implications: Often leads to litigation in postoperative cases

HCC Information

HCC Status: Does NOT map to any HCC category

  • Risk Adjustment: This diagnosis does not contribute to HCC risk adjustment
  • CMS-HCC Model: Not included in V24 or V28 models
  • Payment Impact: No direct RAF impact for Medicare Advantage plans

Important Coding Notes:

  • While not an HCC, this is a serious complication that requires extensive documentation
  • If this is a postoperative complication, may need additional complication codes
  • May affect hospital quality metrics and complication rates
  • Document POA (Present On Admission) status carefully for postoperative cases
  • If this results in blindness or severe vision loss, capture the visual impairment code separately (H54.-)

Quality Reporting Implications:

  • May trigger Hospital-Acquired Condition (HAC) review if postoperative
  • Can affect surgical complication rates
  • Important for ophthalmology practice quality metrics
  • Track outcomes for surgical quality improvement

wRVU / Assistant Surgeon Information

Note

wRVU (work Relative Value Units) and assistant surgeon payability apply to CPT procedure codes, not ICD-10 diagnosis codes. This is a diagnosis code used for reporting the patient’s condition, not a procedural code for billing services rendered.

Vitrectomy Procedures:

  • 67036 - Vitrectomy, mechanical, pars plana approach (partial vitrectomy)
    • wRVU: ~14.48
    • Assistant Surgeon: Payable (typically 16% of fee)
    • Global Period: 90 days
  • 67036 + 67039 - With focal endolaser photocoagulation
    • Additional wRVU for 67039: ~4.50

Intravitreal Injections (Initial treatment):

  • 67028 - Intravitreal injection of a pharmacologic agent
    • wRVU: ~1.34
    • Assistant Surgeon: Not typically payable
    • Global Period: 0 days
    • Usually performed for initial antibiotic injection

Vitreous Tap/Biopsy:

  • 67015 - Aspiration or release of vitreous, subretinal or choroidal fluid
    • wRVU: ~3.71
    • Assistant Surgeon: Not typically payable
    • Often performed for culture/diagnosis

Additional Procedures:

  • 65930 - Removal of blood clot, anterior segment, eye
  • 65800 - Paracentesis of anterior chamber (aqueous tap)
  • 67101 - Repair of retinal detachment (if complication occurs)
  • 65091/65093 - Evisceration of ocular contents (if globe cannot be saved)
  • 65103/65105 - Enucleation of eye (if globe cannot be saved)

Code Tree Hierarchy

H00-H59: Diseases of the Eye and Adnexa
└── H43-H44: Disorders of Vitreous Body and Globe
    └── H44: Disorders of Globe
        └── H44.0: Purulent Endophthalmitis
            ├── H44.00: Unspecified purulent endophthalmitis
            │   ├── H44.001: Right eye ◄ THIS CODE
            │   ├── H44.002: Left eye
            │   ├── H44.003: Bilateral
            │   └── H44.009: Unspecified eye
            ├── H44.01: Panophthalmitis (acute)
            │   ├── H44.011: Right eye
            │   ├── H44.012: Left eye
            │   ├── H44.013: Bilateral
            │   └── H44.019: Unspecified eye
            └── H44.02: Vitreous abscess (chronic)
                ├── H44.021: Right eye
                ├── H44.022: Left eye
                ├── H44.023: Bilateral
                └── H44.029: Unspecified eye

H44.1: Other endophthalmitis
├── H44.11: Panuveitis
├── H44.12: Parasitic endophthalmitis
├── H44.13: Sympathetic uveitis
└── H44.19: Other endophthalmitis

H44.2: Degenerative myopia
H44.3: Other and unspecified degenerative disorders of globe
H44.4: Hypotony of eye
H44.5: Degenerated conditions of globe
H44.6: Retained (old) intraocular foreign body, magnetic
H44.7: Retained (old) intraocular foreign body, nonmagnetic
H44.8: Other disorders of globe
H44.9: Unspecified disorder of globe

Includes

The code H44.001 specifically includes:

  • Acute purulent intraocular infection, right eye
  • Bacterial endophthalmitis, right eye, when organism not specified
  • Suppurative endophthalmitis, right eye
  • Intraocular infection with pus formation, right eye
  • Vitritis with purulent exudate, right eye
  • Endophthalmitis NOS (not otherwise specified), right eye, when purulent

Excludes

Excludes1 (NOT CODED TOGETHER - mutually exclusive)

  • H44.11-H44.13: Other specific types of endophthalmitis:
    • H44.111: Panuveitis, right eye (inflammation of all uveal structures, not necessarily purulent)
    • H44.121: Parasitic endophthalmitis, right eye (use when parasite identified)
    • H44.131: Sympathetic uveitis, right eye (autoimmune response to trauma in fellow eye)

Excludes2 (CAN BE CODED TOGETHER if both conditions present)

  • P39.1: Neonatal conjunctivitis and dacryocystitis (different condition in newborns)
  • A54.31: Gonococcal endophthalmitis (use when Neisseria gonorrhoeae confirmed)
  • T81.4-: Infection following a procedure (use as additional code for postoperative cases)

If organism is known, code more specifically:

  • B37.84: Candidal endophthalmitis (fungal)
  • A54.31: Gonococcal endophthalmitis
  • B00.51: Herpetic iridocyclitis and iridocyclitis (viral)

If specific type is known, use instead of H44.001:

  • H44.011: Panophthalmitis, right eye (when infection involves all layers including sclera)
  • H44.021: Vitreous abscess (chronic), right eye (when chronic abscess rather than acute endophthalmitis)

Post-procedural complications:

  • H59.4-: Inflammation (infection) following ophthalmic procedure (use as additional code)
  • T81.4XXA: Infection following a procedure, initial encounter (use as additional code)
  • T85.79XA: Infection and inflammatory reaction due to other internal prosthetic devices (for IOL-related infections)

Visual impairment sequelae:

  • H54.-: Visual impairment codes (if permanent vision loss results)

MS-DRG Grouping

H44.001 may contribute to the following MS-DRG assignments depending on procedures, complications, and comorbidities:

Primary MS-DRG Assignments (Medical)

Without OR Procedure:

  • MS-DRG 124: Other Disorders of the Eye with MCC Age >17

    • Geometric Mean LOS: 4.9 days
    • Relative Weight: 1.4124 (FY2025)
    • Description: Severe eye disorders with major complications

  • MS-DRG 125: Other Disorders of the Eye without MCC Age >17

    • Geometric Mean LOS: 3.4 days
    • Relative Weight: 0.8458
    • Description: Eye disorders without major complications

Surgical MS-DRG Assignments (With OR Procedure)

If Vitrectomy Performed (CPT 67036, 67039, 67040):

  • MS-DRG 113: Orbital Procedures with CC/MCC

    • Geometric Mean LOS: 2.8 days
    • Relative Weight: 1.8563
    • Description: Intraocular surgical procedures with complications

  • MS-DRG 114: Orbital Procedures without CC/MCC

    • Geometric Mean LOS: 1.5 days
    • Relative Weight: 1.1837
    • Description: Intraocular surgical procedures without complications

If Enucleation/Evisceration Required (CPT 65091, 65093, 65103, 65105):

  • MS-DRG 113: Orbital Procedures with CC/MCC
    • Geometric Mean LOS: 2.8 days
    • Relative Weight: 1.8563

DRG Assignment Factors

Factors that may result in MCC assignment:

  • Sepsis (A41.-)
  • Respiratory failure
  • Acute renal failure
  • Other severe systemic complications

Factors that may result in CC assignment:

  • Diabetes mellitus with complications
  • Hypertension with complications
  • COPD
  • Post-procedural infection codes

POA (Present on Admission) Impact

Critical for DRG Payment:

  • POA = Y (Yes): Endophthalmitis present on admission
    • Full DRG payment
    • Not considered hospital-acquired complication
  • POA = N (No): Endophthalmitis NOT present on admission
    • If postoperative → May be considered Hospital-Acquired Condition (HAC)
    • Potential payment reduction
    • Quality metric impact
    • Triggers review if complication of cataract surgery
  • POA = U (Unknown): Documentation insufficient
    • Treated as POA = N for payment purposes
    • ALWAYS avoid this designation

Coding Guidelines

ICD-10-CM Official Guidelines

1. Laterality Requirement

  • MUST specify laterality (right, left, bilateral)
  • H44.001 = RIGHT eye only
  • Do NOT use H44.009 (unspecified eye) when laterality is documented
  • If bilateral endophthalmitis, use H44.003

2. Organism Coding

  • Code H44.001 when organism is unknown or unspecified
  • When organism is identified, code:
    • H44.001 (endophthalmitis)
    • PLUS organism code (B95-B97 series)
    • Example: H44.001 + B95.8 for Staphylococcus aureus

3. Postoperative Endophthalmitis

  • Code H44.001 (the endophthalmitis)
  • PLUS H59.4- (Inflammation following ophthalmic procedure)
  • PLUS T81.4XXA (Infection following a procedure)
  • PLUS procedural complication code if applicable
  • Sequence depends on circumstances of admission

4. Traumatic Endophthalmitis

  • Code H44.001 (the endophthalmitis)
  • PLUS appropriate injury code (S05.-)
  • PLUS external cause code (W-, X-, Y- series)
  • Follow sequencing rules for injury coding

5. Endogenous Endophthalmitis

  • Code H44.001 (the endophthalmitis)
  • PLUS underlying condition (sepsis, endocarditis, etc.)
  • PLUS organism code
  • Sequence underlying condition first if reason for admission

6. Sequencing

  • Principal diagnosis: The condition established after study to be chiefly responsible for admission
    • If admitted FOR endophthalmitis treatment → H44.001 is principal
    • If endophthalmitis develops DURING admission for other reason → Other condition is principal
    • If admitted for surgery that results in endophthalmitis → Depends on POA

Documentation Requirements

Essential Documentation Elements:

  1. Laterality (right/left/bilateral) - MANDATORY
  2. Timing:
    • Date of onset
    • Relationship to any procedure (if postoperative)
    • Acute vs chronic
  3. Severity:
    • Visual acuity at presentation and throughout course
    • Extent of inflammation (anterior chamber, vitreous)
    • Presence of hypopyon
  4. Etiology (if known):
    • Postoperative (specify procedure and date)
    • Post-traumatic (specify injury)
    • Endogenous (specify source)
  5. Organism (if identified):
    • Culture results from vitreous/aqueous tap
    • Gram stain results
  6. Treatment:
    • Intravitreal antibiotics (agents and doses)
    • Vitrectomy (if performed)
    • Systemic antibiotics
  7. Complications:
    • Retinal detachment
    • Vision loss
    • Need for enucleation/evisceration
  8. POA Status (for inpatient):
    • Was this present on admission?
    • Clear documentation of timing

Query Opportunities

Query physician when documentation states:

  1. “Endophthalmitis” without specifying:

    • Which eye (right/left/bilateral)
    • Whether purulent or non-purulent
    • Timing (acute vs chronic)

  2. “Postoperative infection” without specifying:

    • Exact location (endophthalmitis vs other ocular infection)
    • Whether present on admission
    • Relationship to procedure

  3. “Vitreous haze” or “vitritis” without clarifying:

    • Whether this represents infectious endophthalmitis
    • Purulent vs non-purulent

  4. “Complicated cataract surgery” without specifying:

    • Nature of complication
    • Timing of complication onset

  5. Organism identified but not linked to endophthalmitis:

    • “Patient has endophthalmitis. Blood culture grew Staph aureus”
    • Query: Is the endophthalmitis caused by Staph aureus?

Special Coding Scenarios

Postoperative Endophthalmitis:

Minimum codes required:
- H44.001 (Endophthalmitis, right eye)
- H59.4- (Inflammation following ophthalmic procedure - specify type)
- T81.4XXA (Infection following a procedure, initial encounter)
- Z98.83 (Pseudophakia - if post-cataract surgery)
- POA indicator (CRITICAL)

Traumatic Endophthalmitis:

Minimum codes required:
- H44.001 (Endophthalmitis, right eye)
- S05.6XXA (Penetrating wound of eye, right eye, initial encounter)
- External cause code (how injury occurred)
- POA = Y (present on admission)

Endogenous Endophthalmitis:

Minimum codes required:
- A41.9 (Sepsis, unspecified - if present) OR source infection
- H44.001 (Endophthalmitis, right eye)
- B95.X or B96.X (Organism code if identified)
- POA = Y (present on admission)

Coding Examples

Example 1: Acute Postoperative Endophthalmitis (Post-Cataract Surgery)

Scenario: 72-year-old female presents to ED 5 days after right eye cataract surgery with decreased vision, pain, and hypopyon in right eye. Diagnosed with acute bacterial endophthalmitis. Undergoes vitreous tap and intravitreal antibiotics. Culture grows Staphylococcus epidermidis. Admitted for observation.

Coding:

  • Principal Diagnosis: H44.001 (Unspecified purulent endophthalmitis, right eye)
  • Secondary Diagnoses:
    • H59.41 (Inflammation (infection) following cataract surgery, right eye)
    • T81.4XXA (Infection following a procedure, initial encounter)
    • B95.7 (Staphylococcus epidermidis as cause of infection)
    • Z98.83 (Pseudophakia)
    • E11.9 (Type 2 diabetes - if present)
  • POA Indicators:
    • H44.001: Y (present on admission)
    • H59.41: Y
    • T81.4XXA: Y
  • Procedures:
    • 67015 (Vitreous tap)
    • 67028 (Intravitreal injection)
  • MS-DRG: 125 (Other Disorders of the Eye without MCC)
  • Discharge Status: Home with ophthalmology follow-up

Example 2: Endophthalmitis Requiring Vitrectomy with MCC

Scenario: 68-year-old male with history of diabetes and CHF admitted with right eye endophthalmitis 10 days post-trabeculectomy for glaucoma. Visual acuity light perception only. Undergoes emergency pars plana vitrectomy. Hospital course complicated by acute systolic heart failure exacerbation requiring ICU stay.

Coding:

  • Principal Diagnosis: H44.001 (Unspecified purulent endophthalmitis, right eye)
  • Secondary Diagnoses:
    • I50.21 (Acute systolic heart failure) - MCC
    • H59.49 (Inflammation following other ophthalmic procedure, right eye)
    • T81.4XXA (Infection following a procedure, initial encounter)
    • E11.3521 (Type 2 diabetes with proliferative diabetic retinopathy with macular edema, right eye)
    • H40.141 (Capsular glaucoma with pseudoexfoliation of lens, right eye)
  • POA Indicators:
    • H44.001: Y
    • I50.21: N (developed during hospitalization)
    • H59.49: Y
    • T81.4XXA: Y
  • Procedures:
    • 67036 (Pars plana vitrectomy)
    • ICD-10-PCS: 08D13ZZ (Extraction of right vitreous, percutaneous approach)
  • MS-DRG: 113 (Orbital Procedures with CC/MCC)
  • LOS: 6 days
  • Discharge Status: Home health

Example 3: Post-Traumatic Endophthalmitis

Scenario: 35-year-old male construction worker presents with penetrating injury to right eye from metal fragment. Develops endophthalmitis within 24 hours. Undergoes primary repair of corneal laceration, foreign body removal, and intravitreal antibiotics.

Coding:

  • Principal Diagnosis: S05.6XXA (Penetrating wound of eyeball with foreign body, right eye, initial encounter)
  • Secondary Diagnoses:
    • H44.001 (Unspecified purulent endophthalmitis, right eye)
    • W31.2XXA (Contact with powered woodworking and forming machines, initial encounter)
    • Y92.69 (Other specified place in industrial or construction area)
    • Y93.H3 (Activity, building and construction)
  • POA Indicators: All Y (present on admission)
  • Procedures:
    • 65235 (Removal of foreign body, intraocular, anterior segment)
    • 65275 (Repair of corneal laceration)
    • 67028 (Intravitreal injection)
  • MS-DRG: 113 (Orbital Procedures with CC/MCC)
  • Discharge Status: Home with close ophthalmology follow-up

Example 4: Endogenous Endophthalmitis Secondary to Bacteremia

Scenario: 58-year-old female with poorly controlled diabetes and history of IV drug use presents with fever, back pain, and decreased vision right eye. Blood cultures positive for MRSA. Diagnosed with MRSA bacteremia, vertebral osteomyelitis, and endogenous endophthalmitis right eye. Treated with IV vancomycin and intravitreal antibiotics.

Coding:

  • Principal Diagnosis: A41.02 (Sepsis due to Methicillin resistant Staphylococcus aureus)
  • Secondary Diagnoses:
    • H44.001 (Unspecified purulent endophthalmitis, right eye)
    • M46.26 (Osteomyelitis of vertebra, lumbar region)
    • B95.62(Methicillin resistant Staphylococcus aureus as cause of infection)
    • E11.65 (Type 2 diabetes with hyperglycemia)
    • F11.20 (Opioid dependence, uncomplicated) - if appropriate
  • POA Indicators: All Y
  • Procedures:
    • 67028 (Intravitreal injection)
    • ICD-10-PCS: 3E033GC (Introduction of other therapeutic substance into peripheral vein, percutaneous)
  • MS-DRG: 870-872 (Septicemia with MV >96 hours or with MCC/CC depending on circumstances)
  • LOS: 14 days
  • Discharge Status: Skilled nursing facility with IV antibiotics

Example 5: Bilateral Endophthalmitis (Rare)

Scenario: 45-year-old immunocompromised patient (HIV with low CD4 count) presents with bilateral endophthalmitis due to disseminated fungal infection (Candida albicans). Admitted for systemic antifungal therapy and bilateral intravitreal antifungal injections.

Coding:

  • Principal Diagnosis: B37.84 (Candidal endophthalmitis)
  • Secondary Diagnoses:
    • H44.003 (Unspecified purulent endophthalmitis, bilateral) - NOTE: May not code this if B37.84 is more specific
    • B20 (HIV disease)
    • Z21 (Asymptomatic HIV infection status) - Use one or the other, not both
  • POA Indicators: All Y
  • Procedures:
    • 67028 × 2 (Bilateral intravitreal injections)
  • MS-DRG: 124 (Other Disorders of the Eye with MCC) - HIV with complications = MCC
  • LOS: 7 days
  • Discharge Status: Home with continued antifungal therapy

Example 6: Endophthalmitis Resulting in Enucleation

Scenario: 80-year-old male with fulminant endophthalmitis right eye unresponsive to vitrectomy and antibiotics. Develops panophthalmitis with scleral involvement. Vision lost. Undergoes enucleation to prevent systemic spread.

Coding:

  • Principal Diagnosis: H44.011 (Panophthalmitis (acute), right eye) - MORE SPECIFIC than H44.001
  • Secondary Diagnoses:
    • H54.41 (Blindness right eye, category 5) - Once eye removed
    • H59.41 (Inflammation following cataract surgery) - if applicable
    • T81.4XXA (Infection following procedure) - if postoperative
    • I50.9 (Heart failure, unspecified) - if present as CC
  • POA Indicators: Varies by circumstance
  • Procedures:
    • 67036 (Vitrectomy)
    • 65103 (Enucleation of eye, with implant)
    • ICD-10-PCS: 08DT0ZZ (Resection of right eye, open approach)
  • MS-DRG: 113 (Orbital Procedures with CC/MCC)
  • LOS: 4 days
  • Discharge Status: Home with prosthetic eye fitting scheduled

Example 7: Suspected Endophthalmitis - Rule Out

Scenario: Patient presents with decreased vision and pain after recent cataract surgery. Concern for endophthalmitis. After examination and anterior chamber tap, diagnosed with severe uveitis but NOT infectious endophthalmitis. Treated with topical and oral steroids.

Coding:

  • Principal Diagnosis: H20.9 (Unspecified iridocyclitis) OR
  • Principal Diagnosis: H59.41 (Inflammation following cataract surgery, right eye)
  • Secondary Diagnoses:
  • DO NOT CODE: H44.001 (since endophthalmitis was ruled out)
  • POA Indicators: Y
  • MS-DRG: 125 (Other Disorders of the Eye without MCC)
  • Note: “Rule out” or “suspected” diagnoses are NOT coded in inpatient setting if ruled out

Example 8: Chronic Vitreous Abscess (Different Code)

Scenario: Patient with known chronic vitreous abscess right eye, admitted for elective vitrectomy and antibiotic therapy. Long-standing condition, not acute.

Coding:

  • Principal Diagnosis: H44.021 (Vitreous abscess (chronic), right eye) - MORE SPECIFIC than H44.001
  • Secondary Diagnoses: As applicable
  • DO NOT USE: H44.001 (this is for acute purulent endophthalmitis, not chronic abscess)
  • Procedures: 67036 (Vitrectomy)
  • MS-DRG: 113 or 114 (Orbital Procedures)

Within Same Category (H44.0- Purulent Endophthalmitis)

  • H44.002: Unspecified purulent endophthalmitis, left eye
  • H44.003: Unspecified purulent endophthalmitis, bilateral
  • H44.009: Unspecified purulent endophthalmitis, unspecified eye (avoid when laterality known)
  • H44.011: Panophthalmitis (acute), right eye - use when all layers including sclera involved
  • H44.012: Panophthalmitis (acute), left eye
  • H44.013: Panophthalmitis (acute), bilateral
  • H44.021: Vitreous abscess (chronic), right eye - use for chronic, not acute
  • H44.022: Vitreous abscess (chronic), left eye
  • H44.023: Vitreous abscess (chronic), bilateral

Other Endophthalmitis Codes (H44.1-)

  • H44.111: Panuveitis, right eye (non-purulent inflammation of all uveal structures)
  • H44.121: Parasitic endophthalmitis, unspecified, right eye
  • H44.131: Sympathetic uveitis, right eye (autoimmune following trauma to other eye)
  • H44.19: Other endophthalmitis (use when type doesn’t fit above categories)

Postoperative Complications

  • H59.41: Inflammation (infection) following cataract surgery
  • H59.42: Inflammation (infection) following other intraocular procedure
  • H59.43: Inflammation (infection) following corneal graft
  • H59.49: Inflammation (infection) following other ophthalmic procedure
  • T81.4XXA: Infection following a procedure, initial encounter
  • T85.79XA: Infection due to other internal prosthetic devices (IOL)

Organism Codes (Use in Addition)

  • B95.61: Staphylococcus aureus (Methicillin susceptible)
  • B95.62: Staphylococcus aureus (MRSA)
  • B95.7: Staphylococcus epidermidis
  • B95.5: Unspecified Staphylococcus
  • B96.5: Pseudomonas species
  • B37.84: Candidal endophthalmitis (code this instead of H44.001 if fungal)
  • A54.31: Gonococcal endophthalmitis (code this instead of H44.001 if gonococcal)

Traumatic Injuries

  • S05.6XXA: Penetrating wound of eyeball with foreign body, right eye
  • S05.1XXA: Contusion of eyeball and orbital tissues, right eye
  • S05.2XXA: Ocular laceration and rupture with prolapse or loss of intraocular tissue

Visual Impairment (Sequelae)

  • H54.41: Blindness, right eye, category 5 (no light perception)
  • H54.42X-: Blindness, right eye, category 4 (light perception)
  • H54.51-: Low vision, right eye, category 1 (visual impairment)

Complications

  • H33.001: Unspecified retinal detachment with retinal break, right eye
  • H44.811: Hemophthalmos, right eye
  • H44.131: Sympathetic uveitis (in fellow eye if bilateral involvement)

Clinical Pearls for Coders

  1. Laterality is MANDATORY: Always use .001 (right), .002 (left), .003 (bilateral), never .009 (unspecified) if laterality is documented anywhere in the chart

  2. POA is CRITICAL: For postoperative endophthalmitis:

    • POA = Y if symptoms present on admission
    • POA = N if developed after admission
    • This affects payment and HAC designation
    • Review admission H&P carefully

  3. Code specificity hierarchy:

    • If organism known → Use organism-specific code (B37.84 for Candida, A54.31 for Gonorrhea)
    • If type known → Use specific type (H44.011 for panophthalmitis, H44.021 for chronic abscess)
    • If unspecified → Use H44.001

  4. Postoperative cases require multiple codes:

    • H44.001 (endophthalmitis)
    • H59.4X (inflammation following ophthalmic procedure - specify type)
    • T81.4XXA (infection following procedure)
    • Organism code if identified
    • Z98.83 if pseudophakic

  5. Don’t confuse with:

    • H20.-: Iridocyclitis/anterior uveitis (inflammation without infection)
    • H30.-: Chorioretinal inflammation (posterior segment only)
    • H43.1-: Vitreous hemorrhage (blood, not pus)
    • H44.19: Other endophthalmitis (when specific type is documented)

  6. Visual acuity documentation is important: While not required for code assignment, visual acuity at presentation and discharge affects:

    • Quality metrics
    • Severity assessment
    • Prognosis
    • Potential subsequent disability codes

  7. Culture results matter: When organism is identified:

    • Update coding to reflect specific organism
    • Add organism code (B95-B97 series)
    • Consider if more specific endophthalmitis code applies

  8. Bilateral endophthalmitis is RARE: If coded:

    • Must have clear documentation of both eyes involved
    • Usually endogenous (hematogenous) source
    • Typically immunocompromised patient
    • Very high mortality/morbidity

  9. “Rule out” endophthalmitis: If final diagnosis rules OUT endophthalmitis:

    • Do NOT code H44.001
    • Code what it actually was (uveitis, inflammation, etc.)
    • Suspected/possible diagnoses are NOT coded as confirmed

  10. Enucleation/Evisceration: If patient loses eye:

    • Still code H44.001 (or more specific code)
    • Add blindness code (H54.41)
    • Code enucleation procedure
    • Affects MS-DRG significantly

  11. Documentation for queries: Query when you see:

    • “Possible endophthalmitis” - confirmed or ruled out?
    • “Postoperative infection” - what type? where?
    • “Right eye infection” - endophthalmitis specifically?
    • Missing laterality anywhere in chart

  12. Quality and legal implications:

    • Postoperative endophthalmitis is tracked for quality
    • Often leads to litigation
    • Accurate documentation protects all parties
    • Clear POA designation is medicolegally important

References for Further Study

  • ICD-10-CM Official Guidelines for Coding and Reporting
  • Endophthalmitis Vitrectomy Study (EVS) Group
  • American Academy of Ophthalmology Preferred Practice Patterns
  • CMS MS-DRG Definitions Manual (Current FY)
  • AHA Coding Clinic for ICD-10-CM/PCS
  • Medicare National Coverage Determinations (NCDs) for ophthalmology procedures

Update History

  • FY2025: No changes to code structure or definition
  • Valid through at least: 2025

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