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v1.0.0
ICD-10 Guide
ICD-10 CodesG90.2

G90.2

Billable

Horner's syndrome

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G90.2 is a billable code used to indicate a diagnosis of horner's syndrome.

Key Diagnostic Point:

Horner's syndrome is a rare neurological condition characterized by a combination of symptoms resulting from disruption of sympathetic nerve pathways supplying the eye and surrounding facial structures. The classic triad of symptoms includes ptosis (drooping of the upper eyelid), miosis (constricted pupil), and anhidrosis (lack of sweating) on the affected side of the face. The syndrome can arise from various underlying causes, including trauma, tumors, or vascular lesions affecting the sympathetic chain. In some cases, it may be associated with pain syndromes, particularly if the underlying cause involves nerve injury or irritation. Autonomic dysfunction is a hallmark of Horner's syndrome, as it reflects the impairment of the sympathetic nervous system. Diagnosis typically involves clinical examination and may be supplemented by imaging studies to identify the underlying cause. Treatment focuses on addressing the underlying condition, and while the symptoms of Horner's syndrome may not resolve, management of associated pain syndromes and other complications is essential for patient care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes requiring differential diagnosis
  • Potential for co-existing conditions affecting coding
  • Need for precise documentation of symptoms and clinical findings
  • Variability in presentation and associated symptoms

Audit Risk Factors

  • Inadequate documentation of the underlying cause
  • Failure to specify associated symptoms
  • Misuse of related codes leading to incorrect coding
  • Lack of clarity in clinical notes regarding the diagnosis

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, imaging results, and history of present illness.

Common Clinical Scenarios

Patients presenting with unilateral ptosis and miosis, often following trauma or surgery.

Billing Considerations

Ensure documentation includes the timeline of symptom onset and any associated pain syndromes.

Ophthalmology

Documentation Requirements

Visual acuity tests, pupil response assessments, and any relevant imaging studies.

Common Clinical Scenarios

Patients with Horner's syndrome presenting with visual disturbances or eyelid abnormalities.

Billing Considerations

Document any ocular symptoms and their impact on daily activities.

Coding Guidelines

Inclusion Criteria

Use G90.2 When
  • According to ICD
  • 10 guidelines, G90
  • 2 should be used when the clinical presentation aligns with Horner's syndrome
  • It is essential to document the underlying cause if known, as this may affect treatment and management

Exclusion Criteria

Do NOT use G90.2 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

92250CPT Code

Ophthalmic examination with dilation

Clinical Scenario

Used when assessing visual function in patients with Horner's syndrome.

Documentation Requirements

Document the findings of the examination and any relevant history.

Specialty Considerations

Ophthalmologists should ensure comprehensive documentation of ocular symptoms.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of Horner's syndrome, improving the accuracy of data collection and enhancing the ability to track outcomes and treatment efficacy.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of Horner's syndrome, improving the accuracy of data collection and enhancing the ability to track outcomes and treatment efficacy.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of Horner's syndrome, improving the accuracy of data collection and enhancing the ability to track outcomes and treatment efficacy.

Resources

Clinical References

  • •
    Horner's Syndrome Overview

Coding & Billing References

  • •
    Horner's Syndrome Overview

Frequently Asked Questions

What are the common causes of Horner's syndrome?

Common causes include trauma, tumors, and vascular lesions affecting the sympathetic nervous system. It can also occur post-surgery or due to neurological conditions.