H51.0 Palsy (spasm) of conjugate gaze

ICD-10-CM Code H51.0: Palsy (spasm) of conjugate gaze

ICD-10-CM code H51.0 designates palsy or spasm of conjugate gaze, a binocular movement disorder where both eyes fail to move together in the same direction. This condition stems from disruptions in neural pathways controlling coordinated gaze. When an underlying neurological condition causes this palsy, coding guidelines generally require the underlying condition to be sequenced as the principal diagnosis. 2 4

Plain-language overview

Code H51.0 describes a binocular movement disorder in which both eyes fail to move together in the same direction due to disruption of the neural pathways controlling coordinated horizontal or vertical gaze. 4

What this code represents

Within the ICD-10-CM system, H51.0 is the specific billable diagnosis code for palsy or spasm of conjugate gaze, and it crosswalks approximately to ICD-9-CM codes 378.81 and 378.82 via General Equivalence Mapping. 4

Clinical context

Gaze palsy refers to a lack of conjugate eye movements resulting from a failure of supranuclear control mechanisms, and can be produced by lesions in areas including the frontal lobe, ventral pedunculo-tegmental pathway, or posterior commissure. 1

Lesions at the pontine paramedian reticular formation or midbrain gaze centers are identified as causing the failure of both eyes to move together in the same direction seen in conjugate gaze palsy. 4

Documentation considerations

When an underlying neurological condition such as stroke or multiple sclerosis is responsible for the conjugate gaze palsy, CDC/NCHS coding guidelines generally require the underlying condition to be sequenced as the principal diagnosis, with H51.0 assigned as an additional code. 4

What the sources add

While the payer policy lists specific ocular nerve palsies like third, fourth, and sixth nerve palsies, it does not include H51.0, whereas the diagnostic reference explicitly identifies H51.0 as the billable code for conjugate gaze palsy. 3 4

The clinical literature explains that gaze palsy involves failed supranuclear control mechanisms, while the coding reference specifies that H51.0 represents the resulting binocular movement disorder where the eyes fail to move together. 1 4

Coding details

The code H51.0 for palsy or spasm of conjugate gaze is listed alongside other specified disorders of binocular movement, including convergence insufficiency and internuclear ophthalmoplegia. 5

Sources

1. ABC of Gaze and Ocular Oscillations — pmc.ncbi.nlm.nih.gov; accessed 2026-07-25.
2. EVS Explore — evsexplore.semantics.cancer.gov; accessed 2026-07-25.
3. Clinical Policy: Chemodenervation of the Eyelid — homestatehealth.com; accessed 2026-07-25.
4. ICD-10 Code H51.0: Conjugate gaze palsy, billable in 2026 — pabau.com; accessed 2026-07-25.
5. Provider Resource Center — prc.hmsa.com; accessed 2026-07-25.
6. H51.0 - Palsy (spasm) of conjugate gaze | ICD-10-CM — unboundmedicine.com; accessed 2026-07-25.