H35.5
H35.5 — Hereditary retinal dystrophy
Non-billable headerICD-10-CM
H35.5 is a non-billable header ICD-10-CM code for hereditary retinal dystrophy. 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.
- dystrophies primarily involving Bruch's membrane (H31.1-)
Other codes that can never be billed with H35.5
These codes carry an Excludes1 note pointing at H35.5. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading H35.5 alone.
Risk adjustment
H35.5 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 H35.5
5 child codes. Green means billable.
Related codes at this level
Codes that share H35. If H35.5 is not quite right, the correct code is usually one of these.
- H35.0Background retinopathy and retinal vascular changes
- H35.1Retinopathy of prematurity
- H35.2Other non-diabetic proliferative retinopathy
- H35.3Degeneration of macula and posterior pole
- H35.4Peripheral retinal degeneration
- H35.6Retinal hemorrhage
- H35.7Separation of retinal layers
- H35.8Other specified retinal disorders
- H35.9Unspecified retinal disorder
Questions about H35.5
- Is H35.5 a billable ICD-10-CM code?
- No. H35.5 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does H35.5 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 H35.5?
- H35.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.