H35.00 — Unspecified background retinopathy
H35.00 is a billable, specific ICD-10-CM code for unspecified background retinopathy. It is valid for submission on a claim.
Risk adjustment
H35.00 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
H35.00 is named in 17 Medicare coverage policies — 16 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A57069Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green)not covered
- A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
- A56550Billing and Coding: Panretinal (Scatter) Laser Photocoagulation
How H35.00 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to H35.00.
- Retinopathy(background)
- Sclerosis, sclerotic›retina(senile) (vascular)
Related codes at this level
Codes that share H35.0. If H35.00 is not quite right, the correct code is usually one of these.
Questions about H35.00
- Is H35.00 a billable ICD-10-CM code?
- Yes. H35.00 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does H35.00 sit in the tabular list?
- Diseases of the eye and adnexa (H00-H59), in the block Disorders of choroid and retina (H30-H36).