🧬 ICD-10 CM H47.322 — Drusen of Optic Disc, Left Eye
Billable Code Confirmed
ICD-10 CM H47.322 is a fully billable, 7-character ICD-10-CM code valid for FY2026 (October 1, 2025 - September 30, 2026). The 6th character “2” specifies the left eye, and the code is complete with no additional characters required for submission. This code is valid for HIPAA-covered electronic transactions and inpatient/outpatient claim submission.
Non-Billable Parent Codes
H47.3 (Other disorders of optic disc) is a non-billable category-level code that requires additional characters to specify the disc disorder type — it cannot be submitted on a claim. H47.32 (Drusen of optic disc) is the non-billable subcategory requiring a 7th character to identify laterality; submitting H47.32 without the laterality digit will result in a claim rejection.
Clinical Context
Optic disc drusen (ODD) are acellular calcified deposits in the prelaminar optic nerve head, distinct from macular/retinal drusen associated with AMD — these are entirely different pathological processes requiring different codes. H47.322 applies specifically to drusen confirmed in the left optic disc and is a common incidental finding on funduscopic exam or optic nerve OCT. The distinction from pseudopapilledema (H47.332) is clinically critical, as ODD can mimic true papilledema and misidentification has significant workup implications.
Code Classification
ICD-10 CM H47.322 is a diagnosis code classified under Chapter 7, Diseases of the Eye and Adnexa (H00-H59) in the ICD-10-CM tabular list. It is a pure diagnosis code and carries no procedure or intervention component.
🔍 Code Description
Optic disc drusen (ODD) are abnormal, acellular deposits composed of calcium, mucopolysaccharides, and nucleic and amino acids that accumulate within the prelaminar optic nerve head over time.1 In the left eye, these deposits are captured under H47.322 and may be superficial (visible on funduscopy) or buried (detectable only via OCT, B-scan ultrasound, or autofluorescence imaging).1,2 The etiology is believed to involve axonal metabolic dysfunction, where mitochondrial byproducts calcify within the nerve fiber layer over years.1 ODD are often asymptomatic but can cause progressive visual field defects, particularly arcuate scotomas, as the drusen compress nerve fibers over time.2 The condition may be unilateral or bilateral, and H47.322 should only be assigned when the clinical documentation clearly specifies the left eye as the affected or primary site.
Optic disc drusen must not be confused with H35.36 (drusen of the macula), which are sub-retinal pigment epithelium deposits associated with age-related macular degeneration — a completely distinct pathology that falls in a different ICD-10-CM chapter subsection.2,3 Clinically, the differentiation matters because ODD management focuses on monitoring intraocular pressure, nerve fiber layer thickness via OCT, and visual field testing, while macular drusen management targets anti-VEGF therapy and AMD staging.3 When both conditions coexist in the same patient, both codes may be assigned with appropriate documentation.
🌳 Code Tree / Hierarchy
H47 — Other disorders of optic [2nd] nerve and visual pathways ❌ Non-billable
│
├── H47.0 — Disorders of optic nerve, NEC ❌ Non-billable
│ ├── H47.01x — Ischemic optic neuropathy ✅ Billable (with laterality)
│ └── H47.09x — Other disorders of optic nerve ✅ Billable (with laterality)
│
├── H47.1 — Papilledema ❌ Non-billable
│ ├── H47.10 — Unspecified papilledema ✅ Billable
│ └── H47.11 — Papilledema associated with increased intracranial pressure ✅ Billable
│
├── H47.3 — Other disorders of optic disc ❌ Non-billable
│ │
│ ├── H47.31 — Coloboma of optic disc ❌ Non-billable (requires laterality)
│ │ ├── H47.311 — Coloboma of optic disc, right eye ✅ Billable
│ │ ├── H47.312 — Coloboma of optic disc, left eye ✅ Billable
│ │ └── H47.313 — Coloboma of optic disc, bilateral ✅ Billable
│ │
│ ├── H47.32 — Drusen of optic disc ❌ Non-billable
│ │ ├── H47.321 — Drusen of optic disc, right eye ✅ Billable
│ │ ├── H47.322 — Drusen of optic disc, left eye ◀ THIS CODE ✅ Billable
│ │ └── H47.323 — Drusen of optic disc, bilateral ✅ Billable
│ │
│ └── H47.33 — Pseudopapilledema of optic disc ❌ Non-billable
│ ├── H47.331 — Pseudopapilledema, right eye ✅ Billable
│ ├── H47.332 — Pseudopapilledema, left eye ✅ Billable
│ └── H47.333 — Pseudopapilledema, bilateral ✅ Billable
ODD vs. Pseudopapilledema — A Critical Distinction
ICD-10 CM H47.332 (pseudopapilledema, left eye) and H47.322 (drusen, left eye) are frequently confused because ODD is the most common cause of pseudopapilledema — however, once confirmed as drusen on OCT/autofluorescence, H47.322 is the correct code; using H47.332 without ruling out true papilledema can trigger unnecessary neurology referrals, LP workups, and payer scrutiny.
Tip
Never assign H47.329 (unspecified eye) when laterality is documented — specificity is required for clean claim submission and payer acceptance. If the ophthalmology or neurology note clearly states “left optic disc drusen,” H47.322 is mandatory. Unspecified laterality codes are considered a coding deficiency in HIM audits and may be flagged during RAC reviews.
✅ Includes
- Hyaline bodies of the optic disc, left eye — an alternative clinical term for ODD used in older literature; maps directly to H47.322.
- Buried optic disc drusen, left eye — refers to deeper deposits not visible on direct funduscopy but confirmed on B-scan ultrasound, OCT, or autofluorescence; still reported as H47.322 when laterality is left.
- Superficial optic disc drusen, left eye — the more visible variant, often described as “glistening” deposits on the disc surface; also maps to H47.322.
❌ Excludes
Excludes 1
No formal Excludes 1 notes appear in the FY2026 tabular list directly under H47.322. However, coders must note that H47.332 (Pseudopapilledema of optic disc, left eye) cannot be coded simultaneously with H47.322 for the same eye in the same encounter — clinically, once ODD is confirmed as the cause of disc elevation, the pseudopapilledema code is superseded by the specificity of the drusen code. Assigning both for the same eye on the same claim would represent a clinical contradiction and is an audit risk.
Danger
The most common Excludes 1-type error in this code family is assigning H47.332 (pseudopapilledema) and H47.322 (drusen) together for the same eye — if imaging confirms drusen as the etiology of the apparent disc elevation, H47.322 alone is correct. Always query the physician or review the imaging report before assigning pseudopapilledema, as payers may deny the more specific drusen code when both appear together.
Excludes 2
- ICD-10 CM H35.36 — Drusen (degenerative) of macula — this code is separately assignable when macular/retinal drusen and optic disc drusen both exist in the same patient; the two conditions are pathologically unrelated, and dual coding is appropriate when documentation supports both diagnoses. The presence of macular drusen does not indicate optic disc drusen, and coders should not assume co-existence without explicit physician documentation.
📋 Clinical Overview
ODD, Pseudopapilledema, and True Papilledema — Coding the Disc Elevation Triad
These three conditions all present with optic disc elevation on funduscopy and are a frequent source of both clinical confusion and coding error. The diagnostic workup — OCT, B-scan ultrasound, LP — drives which code is ultimately supported by documentation, and the coder must not assign the code until the physician has documented the confirmed etiology.
| Feature | H47.322 | H47.332 | H47.11 |
|---|---|---|---|
| Etiology | Calcified axonal deposits in prelaminar optic nerve; left eye | Disc elevation without confirmed cause, often ODD-related; left eye | True optic disc swelling due to elevated intracranial pressure |
| Diagnostic Confirmation | OCT, B-scan ultrasound, autofluorescence imaging | Clinical exam with unconfirmed etiology | MRI, LP with opening pressure >25 cmH₂O |
| Visual Risk | Progressive arcuate scotomas possible; central vision usually preserved | Depends on underlying cause | Potential for severe bilateral vision loss if untreated |
| Coding Trigger | Imaging report confirms ODD left disc | Elevated disc documented, no definitive cause confirmed yet | Neuro-ophthalmology or neurology note confirms elevated ICP |
| Common Comorbid Code | H40.x (glaucoma suspect) when IOP is elevated | May later convert to H47.322 if ODD confirmed | G93.2 (benign intracranial hypertension) |
Important
CDI trigger: When a patient presents for inpatient admission and the admitting diagnosis is “papilledema” or “disc swelling,” the CDI team should query whether imaging has confirmed ODD — if it has, the more specific H47.322 (or bilateral H47.323) should replace the papilledema code, which affects DRG assignment and clinical documentation integrity. Physicians frequently do not update the diagnosis after imaging results, creating a documentation gap that inpatient coders need to flag.
Manifestations & Symptom Burden
- Visual field defects (arcuate scotomas) — the most common complication; caused by chronic compression of nerve fiber bundles by enlarging drusen; coded separately using H53.40x (unspecified visual field defects) with appropriate laterality when documented.
- Transient visual obscurations — brief, seconds-long episodes of vision darkening triggered by postural changes; clinically important but not separately ICD-10-CM codeable unless documented as a distinct diagnosis.
- Elevated intraocular pressure (IOP) — ODD can mechanically reduce axoplasmic flow, compounding glaucomatous damage; when a glaucoma diagnosis is confirmed, H40.x codes are assigned in addition to H47.322.
- Progressive optic nerve atrophy — in advanced or longstanding ODD, optic atrophy may develop and should be coded with H47.20x (unspecified optic atrophy with laterality character) if separately documented.
- Incidental finding on routine exam — many ODD cases are asymptomatic discoveries during dilated fundus exams; the code remains valid as an additional diagnosis when it alters monitoring or management.
Tip
Manifestation coding does not apply here in the traditional sense — ODD is not a manifestation of a systemic condition, so the “code first” or “use additional code” convention is not triggered by H47.322 itself. However, coders should review the full note for separately documented visual field loss, optic atrophy, or elevated IOP, as these may be reportable additional diagnoses that add clinical detail to the account. In the inpatient setting, secondary diagnoses meeting UHDDS criteria (evaluated, treated, or increasing nursing care/LOS) must be captured even when ODD is not the principal diagnosis.
💰 HCC Risk Adjustment
| HCC Model | HCC Category | HCC Label | RAF Impact |
|---|---|---|---|
| CMS-HCC v28 | Not mapped | N/A | None |
| CMS-HCC v24 (legacy) | Not mapped | N/A | None |
| HHS-HCC (ACA) | Not mapped | N/A | None |
| CDPS | Not mapped | N/A | None |
ICD-10 CM H47.322 does not carry any HCC weight under any current major risk adjustment model, including CMS-HCC v28 (effective 2024) and HHS-HCC used in the ACA marketplace.4 This means the code will not contribute to a patient’s RAF score, will not trigger hierarchical condition category capture campaigns, and does not require annual recapture for Medicare Advantage quality metrics.4 Coders and CDI specialists should not prioritize this code for risk adjustment outreach, but it remains critical for accurate clinical profiling and medical necessity support for associated ophthalmic testing. Payers utilizing value-based care models may still track this condition for care coordination, even in the absence of a RAF value.
🏥 MS-DRG Assignment
| MS-DRG | Title | Type | Relative Weight (FY2026) | ALOS |
|---|---|---|---|---|
| 123 | Neurological Eye Disorders | Medical | 0.7986 | 2.1 days |
ICD-10 CM H47.322, when sequenced as the principal diagnosis in an inpatient setting, assigns to MS-DRG 123 (Neurological Eye Disorders) under MDC 02 (Diseases and Disorders of the Eye) — a single, undivided DRG with no CC or MCC split variant.5 The relative weight of approximately 0.7986 reflects a lower resource utilization profile, consistent with the typically uncomplicated inpatient course of ODD.5 Because DRG 123 has no CC/MCC refinement, secondary diagnoses do not shift the case to a higher-weighted DRG within this grouping, so CDI efforts aimed at capturing CCs/MCCs will not produce a DRG change here.5 However, if a comorbidity such as acute glaucoma or elevated intracranial pressure is more resource-intensive and better reflects the reason for admission, sequencing that condition as principal may result in assignment to DRG 124 (Other Disorders of the Eye with MCC) or another MDC 02 DRG with a higher weight. Coders should always apply the UHDDS principal diagnosis definition and never default to H47.322 as principal simply because it is listed first in the physician’s note.
🔗 Related ICD-10-CM Codes
Optic Disc and Nerve Disorders (Same Anatomical Region)
- H47.321 — Drusen of optic disc, right eye — assign when right eye is affected; use H47.323 for bilateral
- H47.323 — Drusen of optic disc, bilateral — do not assign alongside H47.321 or H47.322 for same condition
- H47.332 — Pseudopapilledema of optic disc, left eye — used prior to imaging confirmation of ODD
- H47.331 — Pseudopapilledema of optic disc, right eye
- H47.312 — Coloboma of optic disc, left eye — congenital disc defect, distinct from acquired drusen
- H47.20x — Optic atrophy — may develop as a late sequela of longstanding ODD
Conditions Frequently Documented Alongside ODD
- H40.x — Glaucoma family — document separately when elevated IOP or confirmed glaucomatous damage is present
- H53.40x — Visual field defects — assign when arcuate scotomas or other field loss is documented
- H35.31x — Nonexudative AMD — may coexist; note that macular drusen (H35.36) are the AMD-associated deposits, not optic disc drusen
- G93.2 — Benign intracranial hypertension — relevant when ODD is being differentiated from true papilledema during the workup
- H47.10 — Unspecified papilledema — may appear in early documentation before imaging confirms ODD; should be updated once confirmed
🛠️ Commonly Associated CPT Codes
- 92133 — Scanning computerized ophthalmic diagnostic imaging (OCT), posterior segment, optic nerve, with interpretation and report, unilateral or bilateral — this is the primary procedure for evaluating optic disc drusen via OCT and is directly linked to H47.322 as a supporting diagnosis on the claim; Medicare and commercial payers (BCBS, Aetna, UHC) widely cover 92133 for ODD monitoring.6,7 Note: 92133 and 92134 cannot be reported at the same patient encounter per CPT instruction and NCCI edit.6
- 92134 — OCT, posterior segment, retina — used when the retina (not optic nerve) is the primary imaging target; if macular drusen (H35.36) are also being evaluated at the same visit, documentation must clearly support a separate diagnosis requiring separate imaging — NCCI bundles 92133 and 92134 together when performed at the same encounter.6
- 92083 — Visual field examination, extended — appropriate when the documentation indicates visual field testing is performed to monitor ODD-related arcuate scotomas; requires physician interpretation and report; supports H47.322 as medical necessity on the claim.7
- 92250 — Fundus photography with interpretation and report — appropriate for documentation of disc drusen appearance, particularly for longitudinal monitoring; accepted by most payers when linked to H47.322 as the supported diagnosis.7
- 99214 / 99215 — Established office visit, moderate/high complexity — the E/M service for the ophthalmology encounter where ODD is managed or newly diagnosed; must be separately documented with MDM or time-based criteria meeting the level billed; do not upcode based on the ODD diagnosis alone without appropriate complexity drivers.
NCCI Bundling Considerations
CPT 92133 (OCT optic nerve) and 92134 (OCT retina) are mutually exclusive per both CPT instruction and NCCI edits — they cannot be billed together at the same patient encounter, even when performed for different diagnoses such as ODD (H47.322) and macular drusen (H35.36) on the same day.6 This is one of the most commonly cited ophthalmology NCCI bundling errors and frequently triggers claim edits from Medicare and commercial payers including Aetna and Cigna. Fundus photography (92250) is generally not bundled with 92133 when both are medically necessary and separately documented, but coders should verify individual payer LCD/NCD policies as Medicaid and some BCBS plans apply additional imaging bundling restrictions.
🔬 ICD-10-PCS Crosswalk
ICD-10-PCS codes are only applicable in the inpatient setting. Optic disc drusen rarely requires surgical intervention; however, the following PCS codes may apply when diagnostic or monitoring procedures are performed during an inpatient stay.
- 08JK0ZZ — Inspection of Left Eye, Open Approach — applicable if a direct ophthalmoscopic examination is formally documented as a procedure during an inpatient admission; rarely coded in most facilities where this is considered routine assessment rather than a distinct procedure.8
- 08JK3ZZ — Inspection of Left Eye, Percutaneous Approach — may apply in the context of slit-lamp or indirect ophthalmoscope examination coded as a procedure; PCS coding of routine eye examinations in the inpatient setting varies by facility coding policy and should follow official PCS guidelines Section B3 and B6.8
- 08HK0YZ — Insertion of Other Device into Left Eye, Open — not typically applicable to ODD but may arise if a device (e.g., pressure monitoring device) is placed during an admission complicated by elevated IOP associated with disc drusen.8
💊 Coding Scenarios and Examples
Scenario 1 — Outpatient Ophthalmology (Monitoring Visit) A 45-year-old female presents to her ophthalmologist for a routine ODD monitoring visit. She was diagnosed with left optic disc drusen 2 years ago. The physician performs an extended visual field test and OCT of the optic nerve (left eye). Mild arcuate scotoma is noted on visual field testing. The physician documents: “Stable drusen of left optic disc with early arcuate scotoma, left eye.”
- Correct coding: H47.322, H53.419 (Visual field defect, unspecified, left eye)
- CPT: 92133 (OCT optic nerve), 92083 (Visual field, extended), 99213 (E/M)
- Sequencing: H47.322 is the primary diagnosis supporting all procedures; H53.419 is the secondary diagnosis documenting the complication.
- CDI note: Ensure the visual field report is in the record — payers may request documentation of the field defect to support medical necessity for both 92083 and the monitoring visit frequency.
Scenario 2 — Inpatient Admission, Neurological Workup A 32-year-old male is admitted through the ED with “bilateral disc swelling, rule out elevated ICP.” MRI brain is negative. LP opening pressure is normal. Ophthalmology performs OCT and B-scan ultrasound, confirming bilateral optic disc drusen. Final attending documentation: “Bilateral optic disc drusen confirmed; pseudopapilledema. No evidence of papilledema or elevated ICP.”
- Correct coding: H47.323 (Drusen of optic disc, bilateral) as principal; no code for pseudopapilledema once ODD is confirmed as the etiology
- MS-DRG: 123 — Neurological Eye Disorders
- Sequencing note: The working diagnosis of “disc swelling” from the ED should be updated in the final coding to the confirmed H47.323; do not code “papilledema” alongside confirmed ODD.
- CDI note: Query the attending if the final note still lists “papilledema” as a diagnosis — this is a common documentation artifact that should be resolved before code assignment.
Scenario 3 — Bilateral ODD Present, Only Left Eye Being Treated Patient has documented bilateral ODD but presents specifically for worsening visual field changes in the left eye only. Ophthalmologist documents: “Progression of arcuate scotoma, left eye, secondary to left optic disc drusen. Right eye stable, no new findings.”
- Correct coding: H47.322 (left eye), H47.321 (right eye, as current documented condition), H53.412 (Scotoma, arcuate, left eye — if documented)
- Sequencing: H47.322 as principal/first-listed given it is the reason for the visit; H47.321 added for the right eye as a separately documented existing condition.
- CDI note: Do not default to H47.323 (bilateral) when the clinical note addresses the two eyes with different acuity or progression — separate laterality codes more accurately reflect the documented clinical picture.
⚠️ Coding Pitfalls and Tips
- Never code H47.32 (non-billable parent) on a claim. H47.32 without the laterality digit is consistently rejected by all payers and will generate a code validity error in the claim scrubber — always use H47.321 (right), H47.322 (left), or H47.323 (bilateral).3
- Do not confuse ODD with macular/retinal drusen. H47.322 (optic disc) and H35.36 (drusen of macula) are completely separate codes — the anatomical location in the documentation drives code selection, and using the wrong code can misdirect clinical care management and payer authorization decisions.2
- Do not code H47.332 and H47.322 for the same eye on the same claim. Once imaging confirms ODD, the pseudopapilledema code is not separately reportable for the same eye — using both creates a clinical contradiction and is an audit flag.3
- Laterality must match the operative/diagnostic report. When OCT (CPT 92133) is performed on the left eye and the claim lists H47.321 (right eye), the payer will deny based on laterality mismatch; always cross-reference the imaging report with the ICD-10-CM code’s laterality digit before billing.6
- DRG 123 has no CC/MCC split — focus on principal diagnosis accuracy. In the inpatient setting, if a comorbidity is more resource-intensive than the ODD itself, evaluate whether a different principal diagnosis should be sequenced to achieve the correct DRG; do not code defensively by defaulting to H47.322 when another condition drove the admission.5
- CPT 92133 and 92134 cannot be reported at the same encounter. This is a hard NCCI edit — even when both the optic nerve and retina are imaged, only one OCT code may be reported per encounter; select the code that matches the primary clinical purpose of the imaging based on the physician’s documented indication.6