H35.4

H35.4: Peripheral retinal degeneration

Non-billable headerICD-10-CM

H35.4 is a non-billable header ICD-10-CM code for peripheral retinal degeneration. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

hereditary retinal degeneration (dystrophy) (H35.5-)

Excludes2: not included here, but may coexist

The excluded condition is not part of this code, but a patient can have both. You may code both.

peripheral retinal degeneration with retinal break (H33.3-)

Excludes2 inherited from the categories above H35.4

Not part of this code, but both may be coded when both are present.

Written on H35: Other retinal disorders

diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)

Other codes that can never be billed with H35.4

Their own Excludes1 notes name this code, so the conflict is not listed above.

H33.1Retinoschisis and retinal cysts

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Code history

Unchanged in every release from FY2024 to FY2027.

Code to one of these instead H35.4

7 child codes. Green means billable.