🧬 ICD-10 CM H44.113 — Panuveitis, Bilateral
Billable Code Confirmed
ICD-10 CM H44.113 is a fully specified 6-character code combining the category H44.1 (other endophthalmitis), subcategory H44.11 (panuveitis), and the 6th-character laterality digit “3” for bilateral involvement, making it billable for FY2026 with no further specificity required.
Non-Billable Parent Codes
H44 (Disorders of globe) is a category header only and cannot be billed. H44.1 (Other endophthalmitis) lacks the laterality and subtype detail required for reimbursement. H44.11 (Panuveitis) still requires a 6th character specifying right eye, left eye, bilateral, or unspecified eye before it becomes billable.
Clinical Context
Selection of H44.113 over its siblings H44.111 or H44.112 depends entirely on documented laterality; panuveitis is defined by simultaneous inflammation of the anterior chamber, vitreous, retina, and choroid, distinguishing it from isolated anterior (iridocyclitis), intermediate (pars planitis), or posterior (chorioretinitis) uveitis.
Code Classification
ICD-10 CM H44.113 is a diagnosis code (ICD-10-CM), not a procedure code; it is reported to capture the presence and laterality of the inflammatory eye disease and does not itself represent any treatment or intervention performed.
🔍 Code Description
ICD-10 CM H44.113 describes panuveitis affecting both eyes — a diffuse inflammatory process involving all three layers of the uveal tract (iris, ciliary body, and choroid) as well as the vitreous and retina simultaneously, rather than being confined to a single anatomic zone. Etiologies span infectious causes (e.g., syphilis, tuberculosis, toxoplasmosis), autoimmune/systemic inflammatory disease (e.g., sarcoidosis, Behçet disease, Vogt-Koyanagi-Harada disease), and idiopathic presentations, and the bilateral pattern often signals a systemic rather than purely localized ocular process.
Clinically, panuveitis carries a high risk of vision-threatening complications including cystoid macular edema, cataract, and glaucoma, and management typically escalates from topical or periocular corticosteroids to systemic immunosuppression or biologic therapy (e.g., adalimumab) when bilateral or recurrent. Coders should distinguish H44.113 from its unilateral siblings H44.111 and H44.112, and from the related but pathophysiologically distinct entity H44.133 (sympathetic uveitis, bilateral), which specifically follows penetrating trauma or surgery to the fellow eye.
🌳 Code Tree / Hierarchy
H44 Disorders of globe ❌ Non-billable
│
├── H44.0- Purulent endophthalmitis ✅ Billable (with laterality)
├── H44.1 Other endophthalmitis ❌ Non-billable
│ │
│ ├── H44.11 Panuveitis ❌ Non-billable (requires laterality)
│ │ │
│ │ ├── H44.111 Panuveitis, right eye ✅ Billable
│ │ ├── H44.112 Panuveitis, left eye ✅ Billable
│ │ ├── H44.113 Panuveitis, bilateral ◀ THIS CODE ✅ Billable
│ │ └── H44.119 Panuveitis, unspecified eye ✅ Billable
│ │
│ ├── H44.13 Sympathetic uveitis ❌ Non-billable (requires laterality)
│ │ │
│ │ ├── H44.131 Sympathetic uveitis, right eye ✅ Billable
│ │ └── H44.133 Sympathetic uveitis, bilateral ✅ Billable
│ │
│ └── H44.19 Other endophthalmitis ❌ Non-billable (requires laterality)
│
└── H44.2- Degenerative myopia ✅ Billable (with laterality)Specificity Matters for Systemic Workup
Selecting H44.113 over unilateral or unspecified-eye alternatives directly signals bilateral disease burden to a payer, which is often the clinical trigger for prior-authorization of systemic immunosuppressive or biologic therapy rather than local ocular treatment alone.
Tip
Always confirm laterality directly from the ophthalmologist’s exam documentation rather than defaulting to “unspecified eye” — H44.119 should be a last resort, since it can trigger payer queries or claim edits when supporting documentation clearly states bilateral involvement.
✅ Includes
- Diffuse inflammation involving anterior chamber, vitreous, retina, and choroid in both eyes simultaneously, regardless of the underlying infectious, autoimmune, or idiopathic etiology.
- Total uveitis or diffuse uveitis affecting both eyes as a clinical synonym for bilateral panuveitis.
❌ Excludes
Excludes 1
- ICD-10 CM H59.413 (Bleb associated endophthalmitis, bilateral) — this is an Excludes1 (mutually exclusive) relationship at the H44.1 category level, since bleb-associated endophthalmitis is specifically a postoperative complication following glaucoma filtering surgery and is never coded as panuveitis, even when the inflammatory pattern appears diffuse.
Danger
Excludes 2
- ICD-10 CM H16.213 (Ophthalmia nodosa, bilateral) — this is an Excludes2 (not included here) relationship, meaning ophthalmia nodosa (a foreign-body-induced granulomatous inflammatory reaction, typically from caterpillar or plant hairs) is a distinct condition from panuveitis but may be coded together with H44.113 if a patient genuinely has both conditions concurrently.
📋 Clinical Overview
Anatomic Pattern of Uveitis
Panuveitis is distinguished from other uveitis subtypes by the anatomic extent of inflammation rather than etiology alone, and this distinction directly drives code selection among the H44.1x, H20.x, and H30.9x families.
| Feature | H44.113 | Related H20.9 | Related H44.133 |
|---|---|---|---|
| Anatomic extent | Anterior chamber, vitreous, retina, and choroid — all involved simultaneously, both eyes. | Anterior chamber only (iris/ciliary body); does not extend to posterior structures. | Full uveal tract inflammation, but specifically triggered by trauma/surgery to the fellow eye (sympathetic ophthalmia). |
| Typical etiology | Systemic infectious or autoimmune disease (sarcoidosis, Behçet, VKH). | Idiopathic, HLA-B27-associated spondyloarthropathy, or infectious anterior segment disease. | Autoimmune reaction to exposed uveal antigen following penetrating ocular trauma/surgery. |
| Treatment escalation | Frequently requires systemic immunosuppression or biologic therapy given bilateral, diffuse involvement. | Often managed with topical corticosteroids and cycloplegics alone. | May require enucleation of the injured eye in severe, refractory cases to preserve the sympathizing eye. |
Important
A CDI query should be triggered whenever documentation says only “uveitis” or “eye inflammation” without specifying anatomic extent (anterior/intermediate/posterior/pan-) and laterality, since these two elements alone determine the correct code family and 6th character.
Manifestations & Symptom Burden
- Blurred vision and floaters from vitreous inflammatory debris affecting both eyes simultaneously.
- Ocular pain and photophobia from anterior chamber involvement.
- Cystoid macular edema as a vision-threatening complication of chronic posterior segment inflammation.
- Elevated intraocular pressure or glaucoma secondary to chronic inflammation or corticosteroid response.
- Cataract formation from chronic inflammation or long-term corticosteroid therapy.
Tip
💰 HCC Risk Adjustment
ICD-10 CM H44.113 does not map to a CMS-HCC V28 category on its own. If the chart also documents resulting visual impairment or blindness, capture the corresponding H54.x code separately, since low-vision/blindness codes carry independent HCC weight — flag this mapping for direct verification against current CMS-HCC V28 model files before relying on it for risk-adjustment reporting.
🏥 MS-DRG Assignment
| DRG | Title | CC/MCC Requirement |
|---|---|---|
| 124 | Other Disorders of the Eye with MCC or Thrombolytic Agent | Requires a qualifying MCC on the same encounter |
| 125 | Other Disorders of the Eye without MCC | Default assignment absent a qualifying MCC |
ICD-10 CM H44.113 groups to MDC 02 and DRG 124/125 when reported as the principal diagnosis; accurate DRG weight depends on complete secondary-diagnosis capture of any coexisting systemic condition serving as an MCC. NCD/LCD note: there is no dedicated National Coverage Determination for panuveitis or uveitis diagnosis itself. Treatment-related services commonly billed alongside this diagnosis — intravitreal corticosteroid implants (e.g., fluocinolone acetonide, dexamethasone), intravitreal injections, fluorescein angiography, and extended ophthalmoscopy — are typically governed by MAC-specific Local Coverage Determinations and Local Coverage Articles rather than a national policy; flag this for direct comparison against your MAC’s current LCD/LCA library and the CMS PFS Lookup Tool before billing associated procedures.
🔗 Related ICD-10-CM Codes
Panuveitis/Endophthalmitis Family
- H44.111 — Panuveitis, right eye
- H44.112 — Panuveitis, left eye
- H44.119 — Panuveitis, unspecified eye
- H44.131 — Sympathetic uveitis, right eye
- H44.133 — Sympathetic uveitis, bilateral
Anatomically Related Uveitis Codes
- H20.9 — Unspecified iridocyclitis (anterior uveitis)
- H30.93 — Unspecified chorioretinal inflammation, bilateral (posterior uveitis)
- H20.813 — Vogt-Koyanagi-Harada disease is coded elsewhere, but associated intermediate uveitis presentations may pair with H20.813 when documented
- H21.9 — Unspecified disorder of iris and ciliary body, when a distinct anterior segment finding coexists
🛠️ Commonly Associated CPT Codes
- 92014 — Comprehensive ophthalmological exam, established patient; used for ongoing panuveitis monitoring visits.
- 92225 — Extended ophthalmoscopy, initial; supports documentation of peripheral retinal/vitreous involvement.
- 92226 — Extended ophthalmoscopy, subsequent; used for follow-up monitoring of posterior segment inflammation.
- 92235 — Fluorescein angiography; commonly used to assess retinal vasculitis or macular edema associated with panuveitis.
- 92250 — Fundus photography with interpretation and report; documents baseline and interval changes in posterior segment inflammation.
- 67028 — Intravitreal injection of a pharmacologic agent; used for corticosteroid or biologic therapy delivery in refractory bilateral disease.
- 66030 — Injection, anterior chamber of eye (medication); may be used for anterior segment-directed pharmacologic treatment.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Apply to a diagnostic or therapeutic procedure code when only the right eye is treated on a given encounter, even though the diagnosis itself is bilateral. |
| -LT | Left Side | Apply to a diagnostic or therapeutic procedure code when only the left eye is treated on a given encounter. |
| -50 | Bilateral | Apply to eligible procedure codes (e.g., intravitreal injection) when the same service is performed on both eyes at the same encounter, consistent with the bilateral nature of H44.113. |
| -25 | Significant E/M | Apply when a significant, separately identifiable E/M service is performed on the same day as a procedure such as intravitreal injection or extended ophthalmoscopy. |
| -59 | Distinct Service | Apply when reporting two ordinarily-bundled ophthalmic diagnostic services on the same date that represent genuinely distinct, separately documented tests. |
| -76 | Repeat Procedure, Same Physician | Apply when a diagnostic test (e.g., fluorescein angiography) is repeated by the same physician later the same day to reassess an acute change in inflammatory status. |
NCCI Bundling Considerations
Extended ophthalmoscopy, fundus photography, and fluorescein angiography are frequently subject to National Correct Coding Initiative edits when billed together on the same date for the same eye; append modifier -59 only when documentation clearly supports two distinct, medically necessary diagnostic studies rather than routine same-visit bundling.
🔬 ICD-10-PCS Crosswalk
Caution
ICD-10 CM H44.113 is a diagnosis code and does not itself map to an ICD-10-PCS procedure code. The crosswalk below reflects procedures commonly performed to treat bilateral panuveitis during an inpatient stay, not a direct translation of the diagnosis itself — flag for verification against your encoder before inpatient use.
08903ZZ— Drainage of right vitreous, percutaneous approach, diagnostic; may be used if a diagnostic vitreous tap/biopsy is performed to identify an infectious etiology of panuveitis.08913ZZ— Drainage of left vitreous, percutaneous approach, diagnostic; left-sided counterpart used when bilateral diagnostic sampling is performed.3E0C3GC— Introduction of other therapeutic substance into eye, percutaneous approach; represents intravitreal corticosteroid or biologic administration, a common inpatient intervention for severe bilateral panuveitis.
💊 Coding Scenarios and Examples
Example 1
Clinical Scenario:
A 34-year-old female with known sarcoidosis is admitted for evaluation of new-onset blurred vision and floaters in both eyes. Ophthalmology confirms panuveitis affecting both eyes on dilated exam, with vitreous haze and retinal vasculitis. Extended ophthalmoscopy is performed bilaterally.
| Field | Code | Rationale |
|---|---|---|
| CPT | 92226--50 | Bilateral extended ophthalmoscopy performed to document posterior segment involvement in both eyes. |
| PDx | H44.113 | Documented bilateral panuveitis is the direct diagnostic finding driving the encounter. |
Tip
Sequence the underlying systemic disease (sarcoidosis) as an additional diagnosis if it is being actively managed during this admission, since it may function as a qualifying MCC for DRG 124.
Example 2
Clinical Scenario:
A 52-year-old male with a history of Behçet disease presents with worsening bilateral panuveitis refractory to topical therapy. The retina specialist performs bilateral intravitreal corticosteroid injections during the same encounter.
| Field | Code | Rationale |
|---|---|---|
| CPT | 67028--50 | Bilateral intravitreal injection reported with modifier -50 since both eyes were treated at the same encounter. |
| CPT 2 | 92014 | Comprehensive established-patient eye exam performed to assess disease activity prior to injection. |
| PDx | H44.113 | Bilateral panuveitis remains the primary indication for the intravitreal therapy. |
Tip
Modifier -25 should be appended to the E/M code only if the exam represents a significant, separately identifiable service beyond the routine pre-injection assessment; document distinct medical decision-making to support this.
Example 3
Clinical Scenario:
A 45-year-old with Vogt-Koyanagi-Harada disease is admitted with acute bilateral vision loss and diffuse uveitis involving the anterior chamber, vitreous, and choroid in both eyes, confirmed by fluorescein angiography showing multifocal pinpoint leakage.
| Field | Code | Rationale |
|---|---|---|
| CPT | 92235 | Fluorescein angiography performed to characterize the diffuse choroidal/retinal involvement pattern typical of VKH-associated panuveitis. |
| PDx | H44.113 | Bilateral panuveitis is the confirmed ocular diagnosis; VKH disease itself should be coded separately as the underlying systemic etiology. |
Tip
Do not omit the underlying systemic autoimmune diagnosis (e.g., VKH) as a secondary code — its absence understates the clinical complexity of the admission and may understate DRG weight if it would otherwise qualify as an MCC.
⚠️ Coding Pitfalls and Tips
- Pitfall 1: Defaulting to H44.119 (unspecified eye) when the chart clearly documents bilateral findings on exam; Tips: Always cross-reference the ophthalmologist’s exam note laterality before finalizing the 6th character.
- Pitfall 2: Coding H44.113 alongside H59.413 for the same postoperative inflammatory presentation; Tips: Review for a recent glaucoma filtering procedure — bleb-associated endophthalmitis is an Excludes1 condition and should replace, not accompany, H44.113 in that context.
- Pitfall 3: Failing to separately code the underlying systemic disease (sarcoidosis, Behçet, VKH) driving the panuveitis; Tips: Query the provider if a systemic etiology is suspected but not explicitly linked in the documentation, since this affects both clinical accuracy and DRG/HCC completeness.
- Pitfall 4: Omitting complication codes such as cystoid macular edema or secondary glaucoma, assuming they are bundled into H44.113; Tips: ICD-10-CM does not bundle uveitis sequelae — code each documented complication separately.
- Pitfall 5: Applying modifier -50 to a diagnostic exam code that does not support bilateral billing under payer policy; Tips: Verify with the CMS PFS Lookup Tool or your MAC’s bilateral-billing indicator for each specific CPT code before appending -50.
- Pitfall 6: Assuming H44.113 carries HCC risk-adjustment weight; Tips: Confirm CMS-HCC V28 mapping status directly from current model files rather than assuming any ocular inflammatory diagnosis is automatically risk-adjusted.
📚 Sources
1. Centers for Medicare & Medicaid Services, National Center for Health Statistics. *ICD-10-CM FY2026 Tabular List and Guidelines.* CMS/NCHS; 2026. 2. ICD10Data.com. *2026 ICD-10-CM Diagnosis Code H44.113 — Panuveitis, Bilateral.* 2026. https://www.icd10data.com/ICD10CM/Codes/H00-H59/H43-H44/H44-/H44.113 3. AAPC. *ICD-10 Code for Other Endophthalmitis — H44.1.* Codify by AAPC; 2026. https://www.aapc.com/codes/icd-10-codes/H44.1 4. Centers for Medicare & Medicaid Services. *Medicare Coverage Database (MCD) — NCD/LCD Search.* CMS.gov; 2026. https://www.cms.gov/medicare-coverage-database 5. PMC. *Intravitreal Therapy for Noninfectious Uveitis: A Review.* National Library of Medicine; 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC5068474Sources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.