H35.161
H35.161 — Retinopathy of prematurity, stage 5, right eye
Billable / specific codeICD-10-CMright
H35.161 is a billable, specific ICD-10-CM code for retinopathy of prematurity, stage 5, right eye. It is valid for submission on a claim.
Risk adjustment
H35.161 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
H35.161 is named in 11 Medicare coverage policies — 11 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- A56672Billing and Coding: Electroretinography (ERG)
- A56692Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
- A56726Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Related codes at this level
Codes that share H35.16. If H35.161 is not quite right, the correct code is usually one of these.
Questions about H35.161
- Is H35.161 a billable ICD-10-CM code?
- Yes. H35.161 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does H35.161 sit in the tabular list?
- Diseases of the eye and adnexa (H00-H59), in the block Disorders of choroid and retina (H30-H36).