Is H35.4 a billable ICD-10-CM code?

No. H35.4 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does H35.4 sit in the tabular list?

Diseases of the eye and adnexa (H00-H59), in the block Disorders of choroid and retina (H30-H36).

What cannot be coded together with H35.4?

H35.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

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-)

Other codes that can never be billed with H35.4

These codes carry an Excludes1 note pointing at H35.4. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading H35.4 alone.

H33.1Retinoschisis and retinal cysts

Risk adjustment

H35.4 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.

Code to one of these instead H35.4

7 child codes. Green means billable.

Related codes at this level

Codes that share H35. If H35.4 is not quite right, the correct code is usually one of these.

Questions about H35.4

Is H35.4 a billable ICD-10-CM code?: No. H35.4 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does H35.4 sit in the tabular list?: Diseases of the eye and adnexa (H00-H59), in the block Disorders of choroid and retina (H30-H36).
What cannot be coded together with H35.4?: H35.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.