Crystal's MCW Coder Hub🧬 ICD-10 CM H44.002 — Unspecified Purulent Endophthalmitis, Left Eye
Billable Code Confirmed — 6 Characters Complete
ICD-10 CM H44.002 is a valid, billable 6-character ICD-10-CM code for FY2025/2026. No additional characters available or required — complete as written.
🦠 MANDATORY Additional Code — Identify the Organism
Per tabular instruction at H44.0: “Use additional code to identify organism” This is not optional — the organism code is REQUIRED when the pathogen has been identified. Culture pending → H44.002 alone acceptable as interim. Update the organism code when results return. Common pairings listed in the Organism Codes section below.
Excludes1 — Bleb-Associated Endophthalmitis Is a Different Code
🔍 Code Description
ICD-10 CM H44.002 classifies unspecified purulent endophthalmitis of the left eye — a severe, vision-threatening intraocular infection involving the vitreous cavity and/or uveal tract of the left eye, characterized by significant intraocular inflammation with purulence, caused by bacterial, fungal, or other infectious organisms. The “unspecified” designation indicates that the clinical documentation does not specify whether the infection constitutes panophthalmitis (all ocular layers involved — H44.012) or a vitreous abscess without pan-involvement (H44.022) — either because the type was not documented, or because the clinical presentation does not yet allow differentiation at the time of coding.
Endophthalmitis is one of the most feared complications in ophthalmology — a true ocular emergency requiring same-day diagnosis and intervention. Causes range from post-operative contamination (most commonly post-cataract surgery) to post-intravitreal injection (anti-VEGF, steroid implants), penetrating trauma, endogenous hematogenous spread, and post-bleb infection (excluded from this code — see H59.4-). Prognosis for visual recovery is largely determined by time to treatment — every hour matters when the vitreous cavity is infected.
🌳 Code Tree / Hierarchy — H44.0 Purulent Endophthalmitis Family
H44 Disorders of Globe
│
└── H44.0 Purulent Endophthalmitis ❌ Non-billable header
│ Excludes1: bleb associated endophthalmitis (H59.4-)
│ Use additional code to identify organism
│
├── H44.00 Unspecified purulent endophthalmitis ❌ Non-billable
│ ├── H44.001 Unspecified — right eye ✅ Billable
│ ├── H44.002 Unspecified — left eye ◀ THIS CODE ✅
│ ├── H44.003 Unspecified — bilateral ✅ Billable
│ └── H44.009 Unspecified — unspecified eye ⚠️ avoid if laterality known
│
├── H44.01 Panophthalmitis (acute) ❌ Non-billable
│ ├── H44.011 Panophthalmitis — right eye ✅ Billable
│ ├── H44.012 Panophthalmitis — left eye ✅ Billable
│ ├── H44.013 Panophthalmitis — bilateral ✅ Billable
│ └── H44.019 Panophthalmitis — unspec eye ⚠️ avoid
│
└── H44.02 Vitreous abscess (chronic) ❌ Non-billable
├── H44.021 Vitreous abscess — right eye ✅ Billable
├── H44.022 Vitreous abscess — left eye ✅ Billable
├── H44.023 Vitreous abscess — bilateral ✅ Billable
└── H44.029 Vitreous abscess — unspec eye ⚠️ avoid
Unspecified vs. Panophthalmitis vs. Vitreous Abscess — Query Guide
Clinical Finding Code to Use (Left Eye) Infection all layers — cornea, uvea, vitreous, sclera H44.012 Panophthalmitis Vitreous abscess, anterior segment relatively spared H44.022 Vitreous abscess Type not documented / unclear H44.002 Unspecified ← This code When documentation says “endophthalmitis” without further specification → H44.002 is correct. Always query for specificity when possible — panophthalmitis (H44.012) is a more specific code and represents a more severe clinical entity.
🦠 Organism Codes — Mandatory Additional Code Pairings
Always Pair H44.002 With an Organism Code When Known
Bacterial Causes — Most Common (Post-Op / Post-Injection)
| Organism | ICD-10-CM Code | Clinical Context |
|---|---|---|
| Staph aureus (MSSA) | B95.61 | Common post-op endophthalmitis |
| Staph aureus (MRSA) | B95.62 | High severity — MRSA endophthalmitis |
| Coagulase-negative Staph (S. epidermidis) | B96.89 | Most common post-cataract surgery pathogen |
| Streptococcus species | B95.5 | Virulent — rapid onset, poor prognosis |
| Pseudomonas aeruginosa | B96.5 | Gram-negative — trauma, contact lens |
| E. coli / other gram-negative | B96.20-B96.29 | Endogenous — GI/GU source |
| Bacillus cereus | B96.89 | Trauma-associated — soil/vegetation |
| Cutibacterium acnes (formerly Propionibacterium) | B96.89 | Delayed chronic post-cataract presentation |
| Other specified bacteria | B96.89 | Use when specific organism identified |
| Unspecified bacteria | B49 or A49.9 | Culture negative — no organism identified |
Fungal Causes — Endogenous > Exogenous
| Organism | ICD-10-CM Code | Clinical Context |
|---|---|---|
| Candida species | B37.5 | Candida endophthalmitis — endogenous, IVDU, TPN, immunocompromised |
| Aspergillus | B44.13 | Endogenous fungal — immunosuppressed, transplant |
| Other fungal | B48.8 | Rare molds — dematiaceous fungi |
Candida Endophthalmitis — Endogenous Route
ICD-10 CM B37.5 (Candida endophthalmitis) is one of the most important pairings for the endogenous endophthalmitis scenario — patients with candidemia from IV lines, TPN, IVDU, recent abdominal surgery, or immunosuppression. Candida endophthalmitis can be bilateral (H44.003 + B37.5) and is a systemic emergency requiring both systemic antifungal therapy AND ophthalmic management. The left eye H44.002 + B37.5 pairing flags the ophthalmologic complication of disseminated candidiasis on the inpatient record.
📊 Etiology Classification — Exogenous vs. Endogenous
Exogenous Endophthalmitis — Organism Enters From Outside
| Cause | Timing | Most Common Organisms | Additional Code |
|---|---|---|---|
| Post-cataract surgery | Acute: <6 weeks; delayed: months-years | CoNS (S. epidermidis), S. aureus, Strep | B96.89, B95.61, B95.5 |
| Post-intravitreal injection (anti-VEGF, steroid) | 1-7 days | CoNS, Strep, gram-negatives | B96.89, B95.5 + T49.5X5A |
| Post-vitrectomy | Days-weeks | Similar to post-cataract | B96.89 |
| Post-trabeculectomy bleb | ❌ NOT THIS CODE | Any organism | → H59.4- (Excludes1!) |
| Penetrating trauma | Acute | Bacillus cereus, gram-negatives, polymicrobial | B96.89, A49.9 |
| Post-keratoplasty | Variable | Strep, fungi |
Endogenous Endophthalmitis — Organism Spreads via Bloodstream
| Source | Most Common Organisms | Additional Codes |
|---|---|---|
| Candida (IVDU, TPN, immunocompromised) | Candida albicans, Candida glabrata | B37.5 + underlying condition |
| Bacterial sepsis | Staph, Strep, gram-negatives | B95.x - B96.x + sepsis code |
| Endocarditis | Strep viridans, Staph aureus | B95.61 + I33.0 |
| Meningitis | Strep, gram-negatives | Organism code + meningitis code |
| GI/GU source (gram-negative) | Klebsiella, E. coli | B96.1, B96.20 |
| Immunocompromised / transplant (Aspergillus) | Aspergillus species | B44.13 |
Endogenous Endophthalmitis Is an Inpatient Diagnosis
Unlike exogenous post-injection or post-op endophthalmitis (often managed outpatient with intravitreal antibiotics), endogenous endophthalmitis — particularly from Candida or bacterial sepsis — is almost always an inpatient diagnosis. The patient is systemically ill, requiring:
- IV antifungal (Candida) or IV antibiotics (bacterial)
- Infectious disease consultation
- Workup for source (echocardiogram, blood cultures, CT abdomen)
- Ophthalmology consultation with possible intravitreal injection
When H44.002 appears in the inpatient setting with a fungal organism code (B37.5, B44.x), always review the record for a sepsis code (A41.x) and the source — these are complex, high-acuity encounters with significant CC/MCC and DRG tier implications.
🏥 Inpatient Coding Considerations
MS-DRG Assignment for H44.002 Encounters
| Scenario | Principal Dx | MDC | DRG Tier |
|---|---|---|---|
| Post-op endophthalmitis — admitted for vitrectomy | H44.002 | MDC 02 — Eye | DRG 124/125/126 by CC/MCC |
| Candida endophthalmitis in septic patient | A41.x sepsis | MDC 18 — Infectious | High-tier DRG — MCC-heavy |
| Endogenous bacterial endophthalmitis, stable | H44.002 | MDC 02 — Eye | DRG 124/125/126 |
| Trauma → endophthalmitis | Trauma code (S05.x) | MDC 02 / MDC 21 | By injury specifics |
When Sepsis Is Present — Sequencing Drives DRG
In endogenous endophthalmitis cases where the patient also has documented sepsis (A41.x):
- If the patient was admitted because of sepsis → A41.x is principal → MDC 18
- If the patient was admitted because of vision changes/endophthalmitis and sepsis is a complication → H44.002 principal → MDC 02
This distinction can mean a difference of thousands of dollars in DRG reimbursement. Review the admission documentation and query if ambiguous.
CC/MCC Impact on DRG Tier
| Additional Finding | Status | Impact |
|---|---|---|
| Sepsis (A41.x) | MCC | → DRG 124 tier |
| Diabetes with complications (E11.6x) | CC | → DRG 125 tier |
| MRSA organism (B95.62) | CC | → DRG 125 tier |
| Vision loss / blindness (H54.x) | CC | → DRG 125 tier |
| Organ failure (AKI, respiratory) | MCC | → DRG 124 tier |
| No CC/MCC | — | → DRG 126 tier |
🔗 Vault Connections — T49.5X5A Link
Post-Injection Endophthalmitis — The H44.002 ↔ T49.5X5A Pairing
🔗 Related ICD-10-CM Codes
H44.0 Purulent Endophthalmitis — Full Code Set
| Code | Description | Use When |
|---|---|---|
| H44.001 | Unspecified purulent endophthalmitis, right eye | Type unknown, right eye |
| H44.002 | Unspecified purulent endophthalmitis, left eye ← THIS CODE | Type unknown, left eye |
| H44.003 | Unspecified purulent endophthalmitis, bilateral | Both eyes |
| H44.009 | Unspecified purulent endophthalmitis, unspecified eye | ⚠️ Query laterality first |
| H44.011 | Panophthalmitis, right eye | All layers infected — right |
| H44.012 | Panophthalmitis, left eye | All layers infected — left |
| H44.021 | Vitreous abscess, right eye | Vitreous cavity abscess — right |
| H44.022 | Vitreous abscess, left eye | Vitreous cavity abscess — left |
Bleb-Associated — Excluded — Different Code Family
| Code | Description | When to Use |
|---|---|---|
| H59.4- | Inflammation and infection of postprocedural bleb | Filtering bleb + infection — NEVER H44.002 |
Other Endophthalmitis Types — H44.1
| Code | Description |
|---|---|
| H44.11x | Sympathetic uveitis |
| H44.12x | Parasitic endophthalmitis, unspecified |
| H44.13x | Parasitic endophthalmitis — cysticercosis |
| H44.19x | Other endophthalmitis |
Commonly Coded Alongside H44.002
| Code | Description | Relationship |
|---|---|---|
| T49.5X5A | Adverse effect of ophthalmological drugs, initial encounter | Post-injection endophthalmitis — mandatory additional |
| B37.5 | Candida endophthalmitis | Fungal — endogenous, immunocompromised |
| B95.61 | MSSA | Bacterial identification — most common post-op |
| B96.89 | Other bacteria | CoNS, Cutibacterium, unspecified gram-positives |
| H35.3211 | Exudative AMD, right eye, active CNV | Underlying condition treated with anti-VEGF |
| Z96.19x | IOL presence | Post-cataract context — IOL in situ |
| A41.x | Sepsis | Endogenous endophthalmitis with systemic infection |
| H54.62 | Legal blindness, left eye, normal right | If vision outcome results in legal blindness |
🛠️ CPT Codes — Endophthalmitis Treatment
| CPT | Description | H44.002 Context |
|---|---|---|
| 67028 | Intravitreal injection of pharmacological agent | Intravitreal vancomycin/ceftazidime/voriconazole — primary treatment |
| 67036 | Vitrectomy, mechanical, pars plana approach | PPV for endophthalmitis — culture + debulking |
| 67039 | Vitrectomy with focal laser | If associated retinal pathology |
| 65800 | Paracentesis of anterior chamber | Aqueous tap for culture — anterior chamber sampling |
| 92014 | Comprehensive ophthalmological exam, established | Ongoing monitoring post-treatment |
| 92134 | OCT posterior segment | Monitoring vitreous clearing, retinal involvement |
EVS — Endophthalmitis Vitrectomy Study Context
The landmark Endophthalmitis Vitrectomy Study (EVS) established that immediate pars plana vitrectomy (67036) is superior to vitreous tap/inject alone when presenting vision is light perception only. When initial vision is hand motions or better, vitreous tap/inject (67028) alone is comparable to immediate PPV. Documentation of presenting visual acuity at the time of endophthalmitis diagnosis is therefore medically and surgically determinative — and should always be present in the record for correct CPT and severity code support.
💊 Coding Scenarios
Scenario 1 — Post-Cataract Surgery Endophthalmitis, Left Eye, Culture Positive
Clinical Vignette: A 74-year-old female underwent uncomplicated left cataract surgery 4 days ago. Returns with pain, decreased vision, hypopyon, and vitritis OS. Vitreous tap performed — culture grows Staphylococcus epidermidis. Intravitreal vancomycin and ceftazidime injected. Impression: Acute post-op purulent endophthalmitis, left eye — coagulase-negative Staph.
ICD-10-CM:
- H44.002 — Unspecified purulent endophthalmitis, left eye (principal — reason for visit)
- B96.89 — Other specified bacteria (CoNS — mandatory organism identification)
- Z96.52 — Presence of left artificial lens (post-cataract context — IOL in situ)
- T81.4XXA — Infection following procedure, initial encounter (post-surgical infection — appropriate additional)
T81.4 vs. T49.5X5A for Post-Op Endophthalmitis
Post-cataract surgical site infection → T81.4XXA (infection following procedure) — the infection is a complication of surgery, not an adverse effect of a drug. Post-intravitreal injection endophthalmitis → T49.5X5A (adverse effect of ophthalmological drug) — the drug/preparation is the vehicle. Know the distinction: scalpel complication = T81.4; drug/injection complication = T49.5X5A.
Scenario 2 — Post-Eylea Injection Endophthalmitis, Left Eye
Clinical Vignette: A 71-year-old male with wet AMD left eye received intravitreal aflibercept (Eylea) 3 days ago. Presents with severe pain, decreased vision to hand motions OS, hypopyon. Impression: Post-injection purulent endophthalmitis, left eye — organism unknown pending culture.
ICD-10-CM:
- H44.002 — Unspecified purulent endophthalmitis, left eye (principal)
- T49.5X5A — Adverse effect of ophthalmological drugs, initial encounter (Eylea = intravitreal ophthalmological preparation — correctly prescribed, correctly administered)
- H35.3212 — Exudative AMD, left eye, active CNV (underlying condition treated)
- (Organism code to be added when culture results return)
Scenario 3 — Candida Endophthalmitis, Left Eye — Endogenous (Inpatient)
Clinical Vignette: A 58-year-old male immunocompromised from recent abdominal surgery and prolonged TPN. Blood cultures grow Candida albicans. Ophthalmology consulted — dilated exam reveals vitritis and white fluffy chorioretinal lesions OS consistent with Candida endophthalmitis. Started on IV micafungin. Impression: Candida endophthalmitis, left eye — endogenous.
ICD-10-CM (Inpatient):
- A41.89 — Sepsis due to other specified organism (Candida sepsis — principal if sepsis drove admission)
- H44.002 — Unspecified purulent endophthalmitis, left eye (additional — ocular manifestation)
- B37.5 — Candida endophthalmitis (mandatory organism identification)
- Z79.52 — Long-term steroid use (if applicable — immunosuppression context)
Candida Sepsis Sequencing
When Candida endophthalmitis is the ocular manifestation of systemic candidiasis/sepsis, the sepsis code sequences first on the inpatient claim if sepsis drove the admission — H44.002 follows as additional. This moves the MS-DRG from MDC 02 (Eye) to MDC 18 (Infectious) — a clinically accurate and potentially higher-reimbursing assignment. Document carefully and sequence based on the reason for admission.
Scenario 4 — Bleb-Associated Endophthalmitis — DO NOT USE H44.002
Clinical Vignette: A 68-year-old male with history of left trabeculectomy for POAG presents with red eye, pain, and vision change OS. Exam: filtering bleb with purulent discharge, hypopyon, vitritis. Impression: Bleb-associated endophthalmitis, left eye.
ICD-10-CM:
- H59.4- — Inflammation and infection of postprocedural bleb (correct code — bleb-associated is Excludes1 from H44.002)
- ❌ H44.002 — DO NOT USE — Excludes1 prohibits this code for bleb-associated endophthalmitis.
⚠️ Coding Pitfalls and Tips
| Pitfall or Tip | |
|---|---|
| ❌ | Never use H44.002 for bleb-associated endophthalmitis — Excludes1 → H59.4- is the only correct code |
| ❌ | Never omit the organism code when pathogen is identified — it’s a mandatory tabular instruction |
| ❌ | Never use H44.009 (unspecified eye) when laterality is documented — left eye = H44.002 |
| ❌ | Never use T49.5X5A for post-operative (surgical) endophthalmitis — use T81.4XXA for post-surgical infection; T49.5X5A is for drug/injection adverse effects |
| ❌ | Never skip sepsis workup documentation for endogenous cases — Candida and bacterial endogenous endophthalmitis have systemic sources that dramatically affect sequencing and DRG |
| ✅ | Query for type when possible — “panophthalmitis” (H44.012) or “vitreous abscess” (H44.022) are more specific than H44.002 |
| ✅ | Post-injection endophthalmitis → always add T49.5X5A — anti-VEGF, Ozurdex, Kenalog intravitreal are ophthalmological preparations |
| ✅ | Add organism code as soon as culture results return — H44.002 alone is acceptable interim, but organism code is mandatory when known |
| ✅ | Candida endophthalmitis → B37.5 + H44.002 — always assess for sepsis code and sequence accordingly |
| ✅ | Document presenting VA at endophthalmitis diagnosis — hand motions vs. light perception drives EVS surgical decision; supports medical necessity for PPV (67036) vs. vitreous tap/inject (67028) |
| ✅ | MRSA (B95.62) = CC — adds DRG tier when documented; prompt organism-specific identification improves capture |
| ✅ | Bilateral candida endophthalmitis = H44.003 + B37.5 — bilateral code when both eyes involved in endogenous spread |
📚 Sources
1. AAPC Codify. “H44.002 — Unspecified purulent endophthalmitis, left eye.” H44.0 tabular instructions: Excludes1 bleb associated endophthalmitis (H59.4-); Use additional code to identify organism. [web:282][web:285]
2. ICDList.com. “H44.002 — Billable, valid for submission FY2025/2026. Not chronic. Unspecified diagnosis codes acceptable when clinical information is unknown.” Full sibling code list confirmed. [web:284]
3. ECGWaves. “H44.002 — Unspecified purulent endophthalmitis, left eye. Classified under H44 Disorders of Globe.” [web:286]
4. NIH VSAC. “H44.00 — Unspecified purulent endophthalmitis. H43-H44 Disorders of Vitreous Body and Globe.” Parent code structure confirmed. [web:291]
5. PMC/NIH. “Managing adverse effects of glaucoma medications.” Clinical reference for topical ophthalmic drug adverse effects context. [web:266]
6. ICD-10-CM Official Guidelines for Coding and Reporting, FY2025. Section I.B — General Coding Guidelines: Use additional code instructions; laterality; unspecified codes. Section I.C.19 — Injury/adverse effect sequencing.
7. Endophthalmitis Vitrectomy Study Research Group. “Results of the Endophthalmitis Vitrectomy Study.” Arch Ophthalmol. 1995;113:1479-1496. EVS criteria for vitreous tap/inject vs. immediate PPV based on presenting VA.