ICD-10 · PDGM grouping
H35 Other retinal disorders
All 175 codes in the H35 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.
ICD-10-CM FY2027 · CMS grouper v07.2.26
Codes in family
175
Can lead a claim
129
Cannot lead a claim
46
What CMS assigns to H35
129 of the 175 codes group to MMTA - Other; 46 are assigned no clinical group. 43 of the 175 count toward the Disease of the Macula and Blindness/Low Vision comorbidity subgroup; 132 are assigned none. 129 of the 175 can lead a claim. CMS attaches a code-first note to 4 of the 175.
- Disease of the Macula and Blindness/Low Vision
Code first
CMS grouper convention 13, on H35.381, H35.382, H35.383, H35.389. Code first:
- poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)
Every code in H35
Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.
| Code | Description | Primary position | Clinical group | Comorbidity subgroup |
|---|---|---|---|---|
| H35.0 Background retinopathy and retinal vascular changes | ||||
| H35.00 | Unspecified background retinopathy | Can lead a claim | A | None |
| H35.01 Changes in retinal vascular appearance | ||||
| H35.011 | Changes in retinal vascular appearance, right eye | Can lead a claim | A | None |
| H35.012 | Changes in retinal vascular appearance, left eye | Can lead a claim | A | None |
| H35.013 | Changes in retinal vascular appearance, bilateral | Can lead a claim | A | None |
| H35.019 | Changes in retinal vascular appearance, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.02 Exudative retinopathy | ||||
| H35.021 | Exudative retinopathy, right eye | Can lead a claim | A | None |
| H35.022 | Exudative retinopathy, left eye | Can lead a claim | A | None |
| H35.023 | Exudative retinopathy, bilateral | Can lead a claim | A | None |
| H35.029 | Exudative retinopathy, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.03 Hypertensive retinopathy | ||||
| H35.031 | Hypertensive retinopathy, right eye | Can lead a claim | A | None |
| H35.032 | Hypertensive retinopathy, left eye | Can lead a claim | A | None |
| H35.033 | Hypertensive retinopathy, bilateral | Can lead a claim | A | None |
| H35.039 | Hypertensive retinopathy, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.04 Retinal micro-aneurysms, unspecified | ||||
| H35.041 | Retinal micro-aneurysms, unspecified, right eye | Can lead a claim | A | None |
| H35.042 | Retinal micro-aneurysms, unspecified, left eye | Can lead a claim | A | None |
| H35.043 | Retinal micro-aneurysms, unspecified, bilateral | Can lead a claim | A | None |
| H35.049 | Retinal micro-aneurysms, unspecified, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.05 Retinal neovascularization, unspecified | ||||
| H35.051 | Retinal neovascularization, unspecified, right eye | Can lead a claim | A | None |
| H35.052 | Retinal neovascularization, unspecified, left eye | Can lead a claim | A | None |
| H35.053 | Retinal neovascularization, unspecified, bilateral | Can lead a claim | A | None |
| H35.059 | Retinal neovascularization, unspecified, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.06 Retinal vasculitis | ||||
| H35.061 | Retinal vasculitis, right eye | Can lead a claim | A | None |
| H35.062 | Retinal vasculitis, left eye | Can lead a claim | A | None |
| H35.063 | Retinal vasculitis, bilateral | Can lead a claim | A | None |
| H35.069 | Retinal vasculitis, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.07 Retinal telangiectasis | ||||
| H35.071 | Retinal telangiectasis, right eye | Can lead a claim | A | None |
| H35.072 | Retinal telangiectasis, left eye | Can lead a claim | A | None |
| H35.073 | Retinal telangiectasis, bilateral | Can lead a claim | A | None |
| H35.079 | Retinal telangiectasis, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.09 | Other intraretinal microvascular abnormalities | Can lead a claim | A | None |
| H35.1 Retinopathy of prematurity | ||||
| H35.10 Retinopathy of prematurity, unspecified | ||||
| H35.101 | Retinopathy of prematurity, unspecified, right eye | Can lead a claim | A | None |
| H35.102 | Retinopathy of prematurity, unspecified, left eye | Can lead a claim | A | None |
| H35.103 | Retinopathy of prematurity, unspecified, bilateral | Can lead a claim | A | None |
| H35.109 | Retinopathy of prematurity, unspecified, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.11 Retinopathy of prematurity, stage 0 | ||||
| H35.111 | Retinopathy of prematurity, stage 0, right eye | Can lead a claim | A | None |
| H35.112 | Retinopathy of prematurity, stage 0, left eye | Can lead a claim | A | None |
| H35.113 | Retinopathy of prematurity, stage 0, bilateral | Can lead a claim | A | None |
| H35.119 | Retinopathy of prematurity, stage 0, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.12 Retinopathy of prematurity, stage 1 | ||||
| H35.121 | Retinopathy of prematurity, stage 1, right eye | Can lead a claim | A | None |
| H35.122 | Retinopathy of prematurity, stage 1, left eye | Can lead a claim | A | None |
| H35.123 | Retinopathy of prematurity, stage 1, bilateral | Can lead a claim | A | None |
| H35.129 | Retinopathy of prematurity, stage 1, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.13 Retinopathy of prematurity, stage 2 | ||||
| H35.131 | Retinopathy of prematurity, stage 2, right eye | Can lead a claim | A | None |
| H35.132 | Retinopathy of prematurity, stage 2, left eye | Can lead a claim | A | None |
| H35.133 | Retinopathy of prematurity, stage 2, bilateral | Can lead a claim | A | None |
| H35.139 | Retinopathy of prematurity, stage 2, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.14 Retinopathy of prematurity, stage 3 | ||||
| H35.141 | Retinopathy of prematurity, stage 3, right eye | Can lead a claim | A | None |
| H35.142 | Retinopathy of prematurity, stage 3, left eye | Can lead a claim | A | None |
| H35.143 | Retinopathy of prematurity, stage 3, bilateral | Can lead a claim | A | None |
| H35.149 | Retinopathy of prematurity, stage 3, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.15 Retinopathy of prematurity, stage 4 | ||||
| H35.151 | Retinopathy of prematurity, stage 4, right eye | Can lead a claim | A | None |
| H35.152 | Retinopathy of prematurity, stage 4, left eye | Can lead a claim | A | None |
| H35.153 | Retinopathy of prematurity, stage 4, bilateral | Can lead a claim | A | None |
| H35.159 | Retinopathy of prematurity, stage 4, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.16 Retinopathy of prematurity, stage 5 | ||||
| H35.161 | Retinopathy of prematurity, stage 5, right eye | Can lead a claim | A | None |
| H35.162 | Retinopathy of prematurity, stage 5, left eye | Can lead a claim | A | None |
| H35.163 | Retinopathy of prematurity, stage 5, bilateral | Can lead a claim | A | None |
| H35.169 | Retinopathy of prematurity, stage 5, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.17 Retrolental fibroplasia | ||||
| H35.171 | Retrolental fibroplasia, right eye | Can lead a claim | A | None |
| H35.172 | Retrolental fibroplasia, left eye | Can lead a claim | A | None |
| H35.173 | Retrolental fibroplasia, bilateral | Can lead a claim | A | None |
| H35.179 | Retrolental fibroplasia, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.2 Other non-diabetic proliferative retinopathy | ||||
| H35.20 | Other non-diabetic proliferative retinopathy, unspecified eyeCMS: Other non-diabetic proliferative retinopathy, unsp eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.21 | Other non-diabetic proliferative retinopathy, right eye | Can lead a claim | A | None |
| H35.22 | Other non-diabetic proliferative retinopathy, left eye | Can lead a claim | A | None |
| H35.23 | Other non-diabetic proliferative retinopathy, bilateral | Can lead a claim | A | None |
| H35.3 Degeneration of macula and posterior pole | ||||
| H35.30 | Unspecified macular degeneration | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | Disease of the Macula and Blindness/Low Vision |
| H35.31 Nonexudative age-related macular degeneration | ||||
| H35.311 Nonexudative age-related macular degeneration, right eye | ||||
| H35.3110 | Nonexudative age-related macular degeneration, right eye, stage unspecifiedCMS: Nexdtve age-related mclr degn, right eye, stage unspecified | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3111 | Nonexudative age-related macular degeneration, right eye, early dry stageCMS: Nexdtve age-related mclr degn, right eye, early dry stage | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3112 | Nonexudative age-related macular degeneration, right eye, intermediate dry stageCMS: Nexdtve age-related mclr degn, right eye, intermed dry stage | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3113 | Nonexudative age-related macular degeneration, right eye, advanced atrophic without subfoveal involvementCMS: Nexdtve age-rel mclr degn, r eye, adv atrpc w/o sbfvl invl | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3114 | Nonexudative age-related macular degeneration, right eye, advanced atrophic with subfoveal involvementCMS: Nexdtve age-rel mclr degn, r eye, adv atrpc with sbfvl invl | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.312 Nonexudative age-related macular degeneration, left eye | ||||
| H35.3120 | Nonexudative age-related macular degeneration, left eye, stage unspecifiedCMS: Nexdtve age-related mclr degn, left eye, stage unspecified | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3121 | Nonexudative age-related macular degeneration, left eye, early dry stageCMS: Nexdtve age-related mclr degn, left eye, early dry stage | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3122 | Nonexudative age-related macular degeneration, left eye, intermediate dry stageCMS: Nexdtve age-related mclr degn, left eye, intermed dry stage | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3123 | Nonexudative age-related macular degeneration, left eye, advanced atrophic without subfoveal involvementCMS: Nexdtve age-rel mclr degn, l eye, adv atrpc w/o sbfvl invl | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3124 | Nonexudative age-related macular degeneration, left eye, advanced atrophic with subfoveal involvementCMS: Nexdtve age-rel mclr degn, l eye, adv atrpc with sbfvl invl | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.313 Nonexudative age-related macular degeneration, bilateral | ||||
| H35.3130 | Nonexudative age-related macular degeneration, bilateral, stage unspecifiedCMS: Nexdtve age-related mclr degn, bilateral, stage unspecified | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3131 | Nonexudative age-related macular degeneration, bilateral, early dry stageCMS: Nexdtve age-related mclr degn, bilateral, early dry stage | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3132 | Nonexudative age-related macular degeneration, bilateral, intermediate dry stageCMS: Nexdtve age-related mclr degn, bilateral, intermed dry stage | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3133 | Nonexudative age-related macular degeneration, bilateral, advanced atrophic without subfoveal involvementCMS: Nexdtve age-rel mclr degn, bi, adv atrpc without sbfvl invl | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3134 | Nonexudative age-related macular degeneration, bilateral, advanced atrophic with subfoveal involvementCMS: Nexdtve age-rel mclr degn, bi, adv atrpc with subfoveal invl | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.319 Nonexudative age-related macular degeneration, unspecified eye | ||||
| H35.3190 | Nonexudative age-related macular degeneration, unspecified eye, stage unspecifiedCMS: Nonexudative age-related mclr degn, unsp, stage unspecified | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.3191 | Nonexudative age-related macular degeneration, unspecified eye, early dry stageCMS: Nonexudative age-related mclr degn, unsp, early dry stage | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.3192 | Nonexudative age-related macular degeneration, unspecified eye, intermediate dry stageCMS: Nonexudative age-related mclr degn, unsp, intermed dry stage | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.3193 | Nonexudative age-related macular degeneration, unspecified eye, advanced atrophic without subfoveal involvementCMS: Nexdtve age-rel mclr degn, unsp, adv atrpc w/o sbfvl invl | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.3194 | Nonexudative age-related macular degeneration, unspecified eye, advanced atrophic with subfoveal involvementCMS: Nexdtve age-rel mclr degn, unsp, adv atrpc with sbfvl invl | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.32 Exudative age-related macular degeneration | ||||
| H35.321 Exudative age-related macular degeneration, right eye | ||||
| H35.3210 | Exudative age-related macular degeneration, right eye, stage unspecifiedCMS: Exudative age-rel mclr degn, right eye, stage unspecified | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | Disease of the Macula and Blindness/Low Vision |
| H35.3211 | Exudative age-related macular degeneration, right eye, with active choroidal neovascularizationCMS: Exdtve age-rel mclr degn, right eye, with actv chrdl neovas | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3212 | Exudative age-related macular degeneration, right eye, with inactive choroidal neovascularizationCMS: Exdtve age-rel mclr degn, right eye, with inact chrdl neovas | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3213 | Exudative age-related macular degeneration, right eye, with inactive scarCMS: Exudative age-rel mclr degn, right eye, with inactive scar | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.322 Exudative age-related macular degeneration, left eye | ||||
| H35.3220 | Exudative age-related macular degeneration, left eye, stage unspecifiedCMS: Exudative age-related mclr degn, left eye, stage unspecified | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | Disease of the Macula and Blindness/Low Vision |
| H35.3221 | Exudative age-related macular degeneration, left eye, with active choroidal neovascularizationCMS: Exdtve age-rel mclr degn, left eye, with actv chrdl neovas | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3222 | Exudative age-related macular degeneration, left eye, with inactive choroidal neovascularizationCMS: Exdtve age-rel mclr degn, left eye, with inact chrdl neovas | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3223 | Exudative age-related macular degeneration, left eye, with inactive scarCMS: Exudative age-rel mclr degn, left eye, with inactive scar | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.323 Exudative age-related macular degeneration, bilateral | ||||
| H35.3230 | Exudative age-related macular degeneration, bilateral, stage unspecifiedCMS: Exudative age-rel mclr degn, bilateral, stage unspecified | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3231 | Exudative age-related macular degeneration, bilateral, with active choroidal neovascularizationCMS: Exudative age-rel mclr degn, bi, with actv chrdl neovas | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3232 | Exudative age-related macular degeneration, bilateral, with inactive choroidal neovascularizationCMS: Exudative age-rel mclr degn, bi, with inact chrdl neovas | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.3233 | Exudative age-related macular degeneration, bilateral, with inactive scarCMS: Exudative age-rel mclr degn, bilateral, with inactive scar | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.329 Exudative age-related macular degeneration, unspecified eye | ||||
| H35.3290 | Exudative age-related macular degeneration, unspecified eye, stage unspecifiedCMS: Exudative age-related mclr degn, unsp, stage unspecified | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.3291 | Exudative age-related macular degeneration, unspecified eye, with active choroidal neovascularizationCMS: Exudative age-rel mclr degn, unsp, with actv chrdl neovas | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.3292 | Exudative age-related macular degeneration, unspecified eye, with inactive choroidal neovascularizationCMS: Exudative age-rel mclr degn, unsp, with inact chrdl neovas | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.3293 | Exudative age-related macular degeneration, unspecified eye, with inactive scarCMS: Exudative age-related mclr degn, unsp, with inactive scar | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.33 | Angioid streaks of macula | Can lead a claim | A | None |
| H35.34 Macular cyst, hole, or pseudohole | ||||
| H35.341 | Macular cyst, hole, or pseudohole, right eye | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.342 | Macular cyst, hole, or pseudohole, left eye | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.343 | Macular cyst, hole, or pseudohole, bilateral | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.349 | Macular cyst, hole, or pseudohole, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.35 Cystoid macular degeneration | ||||
| H35.351 | Cystoid macular degeneration, right eye | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.352 | Cystoid macular degeneration, left eye | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.353 | Cystoid macular degeneration, bilateral | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.359 | Cystoid macular degeneration, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.36 Drusen (degenerative) of macula | ||||
| H35.361 | Drusen (degenerative) of macula, right eye | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.362 | Drusen (degenerative) of macula, left eye | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.363 | Drusen (degenerative) of macula, bilateral | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.369 | Drusen (degenerative) of macula, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.37 Puckering of macula | ||||
| H35.371 | Puckering of macula, right eye | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.372 | Puckering of macula, left eye | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.373 | Puckering of macula, bilateral | Can lead a claim | A | Disease of the Macula and Blindness/Low Vision |
| H35.379 | Puckering of macula, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.38 Toxic maculopathy | ||||
| H35.381 | Toxic maculopathy, right eye | Can lead a claim, code first applies | A | Disease of the Macula and Blindness/Low Vision |
| H35.382 | Toxic maculopathy, left eye | Can lead a claim, code first applies | A | Disease of the Macula and Blindness/Low Vision |
| H35.383 | Toxic maculopathy, bilateral | Can lead a claim, code first applies | A | Disease of the Macula and Blindness/Low Vision |
| H35.389 | Toxic maculopathy, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.4 Peripheral retinal degeneration | ||||
| H35.40 | Unspecified peripheral retinal degeneration | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.41 Lattice degeneration of retina | ||||
| H35.411 | Lattice degeneration of retina, right eye | Can lead a claim | A | None |
| H35.412 | Lattice degeneration of retina, left eye | Can lead a claim | A | None |
| H35.413 | Lattice degeneration of retina, bilateral | Can lead a claim | A | None |
| H35.419 | Lattice degeneration of retina, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.42 Microcystoid degeneration of retina | ||||
| H35.421 | Microcystoid degeneration of retina, right eye | Can lead a claim | A | None |
| H35.422 | Microcystoid degeneration of retina, left eye | Can lead a claim | A | None |
| H35.423 | Microcystoid degeneration of retina, bilateral | Can lead a claim | A | None |
| H35.429 | Microcystoid degeneration of retina, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.43 Paving stone degeneration of retina | ||||
| H35.431 | Paving stone degeneration of retina, right eye | Can lead a claim | A | None |
| H35.432 | Paving stone degeneration of retina, left eye | Can lead a claim | A | None |
| H35.433 | Paving stone degeneration of retina, bilateral | Can lead a claim | A | None |
| H35.439 | Paving stone degeneration of retina, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.44 Age-related reticular degeneration of retina | ||||
| H35.441 | Age-related reticular degeneration of retina, right eye | Can lead a claim | A | None |
| H35.442 | Age-related reticular degeneration of retina, left eye | Can lead a claim | A | None |
| H35.443 | Age-related reticular degeneration of retina, bilateral | Can lead a claim | A | None |
| H35.449 | Age-related reticular degeneration of retina, unspecified eyeCMS: Age-related reticular degeneration of retina, unsp eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.45 Secondary pigmentary degeneration | ||||
| H35.451 | Secondary pigmentary degeneration, right eye | Can lead a claim | A | None |
| H35.452 | Secondary pigmentary degeneration, left eye | Can lead a claim | A | None |
| H35.453 | Secondary pigmentary degeneration, bilateral | Can lead a claim | A | None |
| H35.459 | Secondary pigmentary degeneration, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.46 Secondary vitreoretinal degeneration | ||||
| H35.461 | Secondary vitreoretinal degeneration, right eye | Can lead a claim | A | None |
| H35.462 | Secondary vitreoretinal degeneration, left eye | Can lead a claim | A | None |
| H35.463 | Secondary vitreoretinal degeneration, bilateral | Can lead a claim | A | None |
| H35.469 | Secondary vitreoretinal degeneration, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.5 Hereditary retinal dystrophy | ||||
| H35.50 | Unspecified hereditary retinal dystrophy | Can lead a claim | A | None |
| H35.51 | Vitreoretinal dystrophy | Can lead a claim | A | None |
| H35.52 | Pigmentary retinal dystrophy | Can lead a claim | A | None |
| H35.53 | Other dystrophies primarily involving the sensory retina | Can lead a claim | A | None |
| H35.54 | Dystrophies primarily involving the retinal pigment epitheliumCMS: Dystrophies primarily w the retinal pigment epithelium | Can lead a claim | A | None |
| H35.6 Retinal hemorrhage | ||||
| H35.60 | Retinal hemorrhage, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.61 | Retinal hemorrhage, right eye | Can lead a claim | A | None |
| H35.62 | Retinal hemorrhage, left eye | Can lead a claim | A | None |
| H35.63 | Retinal hemorrhage, bilateral | Can lead a claim | A | None |
| H35.7 Separation of retinal layers | ||||
| H35.70 | Unspecified separation of retinal layers | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.71 Central serous chorioretinopathy | ||||
| H35.711 | Central serous chorioretinopathy, right eye | Can lead a claim | A | None |
| H35.712 | Central serous chorioretinopathy, left eye | Can lead a claim | A | None |
| H35.713 | Central serous chorioretinopathy, bilateral | Can lead a claim | A | None |
| H35.719 | Central serous chorioretinopathy, unspecified eye | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H35.72 Serous detachment of retinal pigment epithelium | ||||
| H35.721 | Serous detachment of retinal pigment epithelium, right eye | Can lead a claim | A | None |
| H35.722 | Serous detachment of retinal pigment epithelium, left eye | Can lead a claim | A | None |
| H35.723 | Serous detachment of retinal pigment epithelium, bilateral | Can lead a claim | A | None |
| H35.729 | Serous detachment of retinal pigment epithelium, unspecified eyeCMS: Serous detachment of retinal pigment epithelium, unsp eye | Cannot lead a claimUnspecified diagnosis code not acceptable as principal diagnosis since there is a more specific code available that would further accurately identify the condition | None | None |
| H35.73 Hemorrhagic detachment of retinal pigment epithelium | ||||
| H35.731 | Hemorrhagic detachment of retinal pigment epithelium, right eyeCMS: Hemorrhagic detach of retinal pigment epithelium, right eye | Can lead a claim | A | None |
| H35.732 | Hemorrhagic detachment of retinal pigment epithelium, left eyeCMS: Hemorrhagic detach of retinal pigment epithelium, left eye | Can lead a claim | A | None |
| H35.733 | Hemorrhagic detachment of retinal pigment epithelium, bilateralCMS: Hemorrhagic detach of retinal pigment epithelium, bilateral | Can lead a claim | A | None |
| H35.739 | Hemorrhagic detachment of retinal pigment epithelium, unspecified eyeCMS: Hemorrhagic detach of retinal pigment epithelium, unsp eye | Cannot lead a claimUnspecified diagnosis code not acceptable as principal diagnosis since there is a more specific code available that would further accurately identify the condition | None | None |
| H35.8 Other specified retinal disorders | ||||
| H35.81 | Retinal edema | Can lead a claim | A | None |
| H35.82 | Retinal ischemia | Can lead a claim | A | None |
| H35.89 | Other specified retinal disorders | Can lead a claim | A | None |
| H35.9 | Unspecified retinal disorder | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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