Crystal's MCW Coder HubH59.092 — Other Disorders of the Left Eye following Cataract Surgery
Code Overview
H59.092 is a billable ICD-10-CM diagnosis code for other disorders of the left eye following cataract surgery. It belongs to the H59.09 subcategory — “Other disorders of the eye following cataract surgery” — within the H59 category for intraoperative and postprocedural complications and disorders of the eye and adnexa, not elsewhere classified.
This is a “not elsewhere classified” (NEC) residual code — meaning it should only be selected when the documented post-cataract complication or disorder of the left eye is clearly a consequence of cataract surgery but does not map to a more specific H59.0 subcategory code (e.g., it is not vitreous syndrome H59.002, bullous keratopathy H59.012, retained lens fragments H59.022, or CME H59.032). Understanding this residual-code nature is the most critical concept for coding and auditing accuracy with H59.092.
Full Code Description
| Element | Detail |
|---|---|
| Full Code | H59.092 |
| Description | Other disorders of the left eye following cataract surgery |
| NEC Designation | Yes — “not elsewhere classified” residual code |
| Billable | Yes |
| Chapter | 7 — Diseases of the Eye and Adnexa (H00-H59) |
| Block | H55-H59 — Other disorders of eye and adnexa |
| Category | H59 — Intraoperative and postprocedural complications and disorders of eye and adnexa, NEC |
| Laterality | Left eye (OS) |
| 7th Character | Not applicable — 5-character billable code, complete as written |
| Valid FY | FY2025 (Oct 1, 2024 - Sep 30, 2025) |
Clinical Description
Because H59.092 is a residual “NEC” code, it encompasses a variety of post-cataract complications that:
-
Definitively follow cataract surgery as a causal chain
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Affect the left eye
-
Do not have a more specific home within the H59.0 subcategory
Understanding what conditions can legitimately be coded here requires knowing both what is explicitly coded elsewhere in H59.0 and what falls through to this residual bucket. The following types of clinical scenarios may appropriately map to H59.092:
Conditions That May Appropriately Be Coded to H59.092 (Left Eye)
Posterior capsule opacification (PCO) presenting as a complication problem:
PCO — often called a “secondary cataract” — is the most common late complication of cataract surgery. Residual lens epithelial cells (LECs) migrate and proliferate across the posterior capsule, creating a fibrous or pearl-like opacity that obstructs the visual axis. Note: ICD-10-CM does classify PCO under H26.4- (secondary cataract), and that subcategory carries an Excludes1 note from H59. However, if the provider frames it explicitly as a post-cataract disorder requiring active management in the context of a cataract complication encounter, the clinical and coding context determines which section applies. PCO is separately indexed as H26.4- and should generally be coded there rather than H59.092 — see Coding Pitfalls section.
Toxic anterior segment syndrome (TASS):
An acute, sterile postoperative inflammatory reaction that occurs within 12-72 hours following intraocular surgery (including cataract extraction). Caused by non-infectious substances entering the anterior segment (endotoxins, enzymatic cleaning agents, impurities in BSS or OVDs, residual material). Presents with diffuse corneal edema, anterior chamber reaction, hypopyon, and potential IOP elevation. Not separately indexed in ICD-10-CM to a more specific H59 code — H59.092 (left eye) is a reasonable code assignment when TASS is documented as the post-cataract complication of the left eye.
Post-cataract elevated intraocular pressure (IOP spike) not classified to a glaucoma code:
Transient or sustained IOP elevation following cataract surgery from viscoelastic retention, inflammation, or steroid response that is documented as a direct post-cataract complication. When this does not rise to the level of a diagnosable glaucoma (H40.-), H59.092 can serve as the appropriate code.
Post-cataract anterior segment inflammation/uveitis not classified elsewhere:
Persistent postoperative anterior chamber reaction, fibrinous uveitis, or iritis following cataract surgery that is distinct from the specific diagnoses indexed in H20.- and is attributed to the surgery itself rather than an independent uveitic condition.
Post-cataract corneal edema without bullous keratopathy:
Mild-to-moderate corneal edema following cataract surgery in the left eye that does not meet the threshold of “bullous aphakic keratopathy” coded at H59.012. Earlier or less severe manifestations may be captured here.
Post-cataract wound-related complications:
Wound dehiscence, filtering bleb, or incision-related issues in the left eye following cataract surgery that are not separately coded by more specific wound complication codes.
Dropped nucleus / vitreous loss complications not indexed to more specific codes:
When documentation describes residual effects or early complications of a dropped nucleus or vitreous loss during cataract surgery that are not specifically captured by retained lens fragments (H59.022) or other specific codes, and the left eye is affected.
Post-cataract macular pucker/epiretinal membrane specifically attributed to surgery:
If an ERM develops and is documented by the provider as a direct post-surgical complication of the cataract procedure (rather than idiopathic), H59.092 may apply until a more specific code captures it.
Code Structure / Code Tree
H00-H59 Diseases of the Eye and Adnexa
└── H55-H59 Other disorders of eye and adnexa
└── H59 Intraoperative and postprocedural complications and disorders of eye and adnexa, NEC
└── H59.0 Disorders of the eye following cataract surgery
├── H59.00 Vitreous (touch) syndrome
│ ├── [[H59.001]] ... right eye
│ ├── [[H59.002]] ... left eye
│ ├── [[H59.003]] ... bilateral
│ └── [[H59.009]] ... unspecified
├── H59.01 Keratopathy (bullous aphakic) following cataract surgery
│ ├── [[H59.011]] ... right eye
│ ├── [[H59.012]] ... left eye
│ ├── [[H59.013]] ... bilateral
│ └── [[H59.019]] ... unspecified
├── H59.02 Cataract (lens) fragments in eye following cataract surgery
│ ├── [[H59.021]] ... right eye
│ ├── [[H59.022]] ... left eye
│ ├── [[H59.023]] ... bilateral
│ └── [[H59.029]] ... unspecified
├── H59.03 Cystoid macular edema following cataract surgery
│ ├── [[H59.031]] ... right eye
│ ├── [[H59.032]] ... left eye
│ ├── [[H59.033]] ... bilateral
│ └── [[H59.039]] ... unspecified
└── H59.09 Other disorders of the eye following cataract surgery ◄ NEC SUBCATEGORY
├── [[H59.091]] ... right eye
├── [[H59.092]] ... left eye ◄ THIS CODE
├── [[H59.093]] ... bilateral
└── [[H59.099 ]] ... unspecified eye
Tip
NEC residual positioning: H59.09 and its laterality subdivisions (including H59.092) are the “catch-all” bucket for post-cataract complications of the eye that have no more specific home in H59.00-H59.03. Before defaulting to H59.092, always verify that the condition isn’t better represented by H59.002 (vitreous syndrome, left), H59.012 (bullous keratopathy, left), H59.022 (lens fragments, left), H59.032 (CME, left), or a non-H59 code in the body system chapters.
Includes / Excludes Notes
Includes (H59.09)
All disorders of the left eye directly following and attributable to cataract surgery that are not representable by:
-
H59.012 — Bullous aphakic keratopathy, left eye
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H59.022 — Cataract lens fragments, left eye
-
H59.032 — Cystoid macular edema, left eye
Conditions potentially captured here when left eye laterality is documented:
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TASS (toxic anterior segment syndrome)
-
Post-cataract IOP spike (without diagnosable glaucoma)
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Post-cataract anterior segment inflammation NEC
-
Post-cataract wound complications NEC
-
Post-cataract corneal edema (not reaching bullous keratopathy threshold)
-
Post-cataract hypotony
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Post-cataract pupillary abnormalities (e.g., corectopia, iris damage from phaco)
Excludes1 (H59 Category — Do Not Code Together When These Are the True Problem)
| Code | Description | Rationale |
|---|---|---|
| T85.2 | Mechanical complication of intraocular lens | IOL dislocation, malposition, or opacification = T85.2, not H59.092 |
| T85.3 | Mechanical complication of other ocular prosthetic devices, implants and grafts | Device-specific mechanical failure |
| Z96.1 | Pseudophakia | Status/history code; not a complication diagnosis |
| H26.4- | Secondary cataracts (PCO, Soemmering’s ring, after-cataract) | PCO has its own specific coding pathway in H26.4-; do not default to H59.092 for PCO |
Important Secondary Distinction
| Code | Description | Versus H59.092 |
|---|---|---|
| H26.41 | Soemmering’s ring | Secondary cataract / PCO type — code here, not H59.092 |
| H26.49 | Other secondary cataracts | PCO and related — code here, not H59.092 |
| H40.4- | Glaucoma secondary to eye inflammation | If post-cataract IOP elevation rises to glaucoma — code H40.4, not H59.092 |
| H20.0- | Acute iridocyclitis | If post-cataract uveitis meets iridocyclitis criteria — code H20, not H59.092 |
HCC (Hierarchical Condition Category) Mapping
H59.092 does NOT map to a CMS-HCC in any current risk adjustment model.
| HCC Model | HCC Assignment | RAF Impact |
|---|---|---|
| CMS-HCC Model V28 | Not assigned | No RAF |
| RxHCC Model | Not assigned | No RAF |
| HHS-HCC (ACA Marketplace) | Not assigned | No RAF |
Documentation note:
As with all H59 codes, H59.092 carries no direct RAF weight. When underlying systemic conditions (e.g., diabetes mellitus E11.- contributing to post-cataract complications) are documented and managed, capture those codes to support comprehensive HCC coding.
MS-DRG Mapping (Inpatient)
H59.092 as principal diagnosis is rare in the inpatient setting. Most conditions that would be coded to H59.092 are managed outpatient unless unusual severity or systemic instability necessitates admission.
| MS-DRG | Description | Trigger |
|---|---|---|
| 124 | Other Disorders of the Eye with MCC | H59.092 as PDx + qualifying MCC present |
| 125 | Other Disorders of the Eye without MCC | H59.092 as PDx, no MCC |
MDC: MDC 02 — Diseases and Disorders of the Eye
CC/MCC Status:
-
H59.092 is not classified as a CC or MCC
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Will not independently upgrade DRG assignment when present as a secondary diagnosis
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The underlying cause of admission (if a systemic condition) drives the DRG; H59.092 represents a secondary post-cataract finding
CPT Procedure Codes (Commonly Associated)
Because H59.092 is a residual NEC code, the CPT procedures associated with it vary widely depending on the actual clinical condition being treated. The following represent common clinical scenarios:
Evaluation and Management
| CPT | Description | wRVU (approx.) |
|---|---|---|
| 92004 | Comprehensive ophthalmological exam, new patient | 2.67 |
| 92014 | Comprehensive ophthalmological exam, established patient | 1.50 |
| 92012 | Intermediate ophthalmological exam, established patient | 0.97 |
| 99213 | Office visit, established patient, low complexity | 1.30 |
| 99214 | Office visit, established patient, moderate complexity | 1.92 |
Diagnostic Testing
| CPT | Description | wRVU (approx.) | Notes |
|---|---|---|---|
| 92134 | OCT posterior segment — for macular evaluation post-cataract | 0.58 | Verify LCD coverage for H59.092 |
| 92132 | OCT anterior segment — for corneal edema, wound integrity, anterior chamber evaluation | 0.58 | Useful for TASS, corneal edema, IOP assessment workup |
| 92100 | Serial tonometry — for IOP spike monitoring post-cataract | 0.50 | |
| 76514 | Corneal pachymetry — for corneal edema thickness measurement | 0.58 | |
| 92235 | Fluorescein angiography — when posterior segment complication suspected | 1.10 | |
| 92020 | Gonioscopy — for IOP elevation evaluation, angle assessment post-surgery | 0.46 |
Therapeutic Procedures (Scenario-Dependent)
| CPT | Description | wRVU (approx.) | Assistant Allowed? |
|---|---|---|---|
| 68200 | Subconjunctival injection (periocular steroid for post-cataract inflammation) | ~0.95 | No |
| 67500 | Retrobulbar injection (steroid) | ~0.61 | No |
| 66821 | YAG laser posterior capsulotomy (for PCO — but note: PCO should be coded H26.4-, not H59.092) | ~3.44 | No |
| 66820 | Discission of secondary membranous cataract, stab incision technique | ~3.44 | No |
| 92310 | Fitting of contact lens, cornea, alone (for bandage contact lens in corneal edema) | ~0.81 | No |
| 65930 | Removal of blood clot, anterior segment | ~5.09 | No |
| Irrigation/washout of OVD | No specific CPT; often part of return to OR coded as the primary procedure performed | varies | Verify per payer |
Assistant Surgeon Payable?
| Service Category | Assistant Allowed? |
|---|---|
| Office evaluation (E/M, ophthalmological exam) | No |
| Diagnostic imaging and testing | No |
| Minor office procedures (injections, contact lens fitting) | No |
| YAG laser procedures | No |
| Major O.R. procedures (if escalation needed, e.g., vitrectomy for dropped nucleus complications) | Verify per CPT and payer |
Coding Examples
Example 1 — TASS (Toxic Anterior Segment Syndrome) After Cataract Surgery, Left Eye
Clinical Scenario:
A 65-year-old male underwent phacoemulsification with IOL implantation OS 36 hours ago. He returns with acute diffuse corneal edema, anterior chamber reaction with fibrin, and marked IOP elevation in the left eye. The surgeon documents “toxic anterior segment syndrome (TASS) following cataract surgery OS.” No infection is suspected; this is a sterile inflammatory response.
ICD-10-CM:
-
H59.092— Other disorders of the left eye following cataract surgery (TASS has no more specific ICD-10-CM code in H59 — this NEC code is appropriate) -
H18.22— Idiopathic corneal edema, left eye (code also: corneal manifestation if documented separately)
CPT:
-
92014— Comprehensive ophthalmological exam -
92132— OCT anterior segment -
68200-LT— Subconjunctival corticosteroid injection, left eye
Coder Note: TASS is not separately indexed in ICD-10-CM’s Alphabetic Index under a specific code. The clinical description points to H59.092 as the NEC post-cataract complication code for the left eye.
Example 2 — Post-Cataract IOP Spike, Left Eye
Clinical Scenario:
A 70-year-old female returns the day after uncomplicated cataract surgery OS with an IOP of 38 mmHg in the left eye. The surgeon attributes it to retained viscoelastic substance (OVD) in the anterior chamber. The clinical note reads “post-cataract IOP spike secondary to retained OVD, OS.” The elevated IOP does not meet criteria for a glaucoma diagnosis.
ICD-10-CM:
H59.092— Other disorders of the left eye following cataract surgery (IOP spike post-cataract not meeting glaucoma threshold; no more specific H59 code exists)
CPT:
-
92012— Intermediate ophthalmological exam -
92100— Serial tonometry (if multiple IOP readings performed)
Example 3 — Post-Cataract Wound Leak, Left Eye
Clinical Scenario:
A 68-year-old patient returns 3 days after cataract surgery OS with a shallow anterior chamber and positive Seidel test at the main incision, indicating a small wound leak. The surgeon documents “post-cataract surgery wound dehiscence/leak, left eye.” No procedure is needed; the wound seals spontaneously with a bandage contact lens.
ICD-10-CM:
-
H59.092— Other disorders of the left eye following cataract surgery (wound leak post-cataract without specific H59 code) -
T81.31XA— Disruption of external operation (surgical) wound, NEC, initial encounter (may be more specific if the wound disruption is the primary coding focus — evaluate)
CPT:
-
92014— Comprehensive ophthalmological exam -
92310-LT— Fitting of bandage contact lens, left eye
Example 4 — Post-Cataract Hypotony, Left Eye
Clinical Scenario:
A 74-year-old patient presents 5 days after cataract surgery OS with IOP of 3 mmHg in the left eye, choroidal folds, and mild anterior chamber shallowing. The surgeon documents “postoperative hypotony, left eye, following cataract surgery.” OCT shows choroidal folds consistent with hypotony maculopathy.
ICD-10-CM:
-
H59.092— Other disorders of the left eye following cataract surgery (post-cataract hypotony not separately indexed in H59) -
H44.42— hypotony of left eye (code also: the specific hypotony, if separately referenced and documented)
CPT:
-
92014— Comprehensive ophthalmological exam -
92134— OCT posterior segment (for choroidal fold/maculopathy documentation)
Example 5 — Persistent Post-Cataract Anterior Chamber Inflammation NEC, Left Eye
Clinical Scenario:
A 63-year-old patient continues to have persistent anterior chamber flare and cells at 6 weeks post-cataract surgery OS that is not consistent with uveitis, TASS, or endophthalmitis. The surgeon documents “persistent post-cataract anterior chamber inflammation, OS, NEC.” No specific inflammatory etiology is identified.
ICD-10-CM:
H59.092— Other disorders of the left eye following cataract surgery (persistent post-surgical inflammation NEC, not meeting H20 uveitis criteria, no more specific H59 code)
CPT:
-
92014— Comprehensive ophthalmological exam -
92132— OCT anterior segment -
68200-LT— Subconjunctival injection if corticosteroid given
Key Coding Pitfalls & Tips
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H59.092 is a residual NEC code — exhaust specificity first. Before using H59.092, always verify the post-cataract left eye complication cannot be captured by: H59.002 (vitreous syndrome), H59.012 (bullous keratopathy), H59.022 (lens fragments), H59.032 (CME), or a body-system-specific code (H20.-, H40.-, H26.4-). Using H59.092 when a more specific code exists is a coding error.
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Do not use H59.092 for PCO. Posterior capsular opacification (secondary cataract) is classified under H26.4- and is subject to the Excludes1 note from H59 — it should not be coded as H59.092.
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Do not use H59.092 for IOL complications. IOL dislocation, displacement, or malfunction belong in T85.2- per the Excludes1 note on H59. Document the distinction clearly.
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Avoid unspecified laterality. H59.099 (unspecified eye) should only be used when the eye truly cannot be determined from the medical record. If the left eye is documented, H59.092 is the correct code.
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Bilateral involvement = H59.093. If both eyes have post-cataract disorders captured under H59.09, use H59.093 rather than coding H59.091 + H59.092 together.
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Document the specific condition, not just “post-op check.” H59.092 is appropriate only when the provider documents an actual disorder or complication of the left eye attributable to cataract surgery. A routine postoperative visit without documented complication should not be coded to H59.092.
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Query the provider when the condition seems specific. If the medical note describes a recognizable condition (e.g., “TASS,” “wound leak,” “IOP spike”), confirm with the provider whether a more specific diagnostic label exists that could point to a more specific code before defaulting to H59.092.
Related Codes (Cross-Reference)
| Code | Description |
|---|---|
| H59.091 | Other disorders of the right eye following cataract surgery |
| H59.093 | Other disorders of the eye following cataract surgery, bilateral |
| H59.099 | Other disorders of the eye following cataract surgery, unspecified eye |
| H59.002 | Vitreous touch syndrome, left eye |
| H59.012 | Keratopathy (bullous aphakic) following cataract surgery, left eye |
| H59.022 | Cataract (lens) fragments in eye following cataract surgery, left eye |
| H59.032 | Cystoid macular edema following cataract surgery, left eye |
| H26.41 | Soemmering’s ring |
| H26.492 | Other secondary cataract, left eye |
| H40.412 | Glaucoma secondary to eye inflammation, left eye |
| H20.012 | Primary iritis, left eye |
| H18.22 | Idiopathic corneal edema, left eye |
| H44.42 | Hypotony of left eye |
| T85.22XA | Displacement of intraocular lens, initial encounter |
| Z98.42 | Cataract extraction status, left eye |
Last Reviewed: 2026-02-18 | Source: ICD-10-CM FY2025, CMS MPFS, AAO Cataract Surgery Coding Guidelines, ICD-10-CM Official Guidelines FY2026