Is H35.54 a billable ICD-10-CM code?

Yes. H35.54 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does H35.54 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 H35.54?

H35.54 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H35.54 (H35.5) and apply to it just the same.

H35.54

H35.54 — Dystrophies primarily involving the retinal pigment epithelium

Billable / specific codeICD-10-CM

H35.54 is a billable, specific ICD-10-CM code for dystrophies primarily involving the retinal pigment epithelium. It is valid for submission on a claim.

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Vitelliform retinal dystrophy

Excludes1 inherited from the categories above H35.54

These are not written on H35.54, but they bind it: a note on a category applies to every code beneath it. Billing H35.54 with anything listed here is a denial.

Written on H35.5 — Hereditary retinal dystrophy

dystrophies primarily involving Bruch's membrane (H31.1-)

Excludes2 inherited from the categories above H35.54

Also inherited, and the opposite of Excludes1: these conditions are not part of H35.54, but a patient can have both, so you may code both.

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)

Risk adjustment

H35.54 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

H35.54 is named in 21 Medicare coverage policies — 21 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
A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
A56551Billing and Coding: Visual Fields Testing
A56672Billing and Coding: Electroretinography (ERG)

How H35.54 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 H35.54.

Dystrophy, dystrophia›tapetoretinal
Dystrophy, dystrophia›retinal›involving›pigment epithelium

Code history

H35.54 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share H35.5. If H35.54 is not quite right, the correct code is usually one of these.

Questions about H35.54

Is H35.54 a billable ICD-10-CM code?: Yes. H35.54 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does H35.54 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 H35.54?: H35.54 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H35.54 (H35.5) and apply to it just the same.