Version 2024

2024 ICD-10-CM Diagnosis Code H18.559

Macular corneal dystrophy, unspecified eye

ICD-10-CM Code:: H18.559
ICD-10 Code for:: Macular corneal dystrophy, unspecified eye
Is Billable?: Yes - Valid for Submission
Chronic Condition Indicator: ^[1]: Not chronic
Code Navigator:

Code Information
Approximate Synonyms
Clinical Classification
Clinical Information
Tabular List of Diseases and Injuries
Diagnostic Related Groups Mapping
Replacement Code
Patient Education
Other Codes Used Similar Conditions
Code History

Code Classification

Diseases of the eye and adnexa
(H00–H59)
- Disorders of sclera, cornea, iris and ciliary body
  (H15-H22)
  - Other disorders of cornea
    (H18)

H18.559 is a billable diagnosis code used to specify a medical diagnosis of macular corneal dystrophy, unspecified eye. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.

Unspecified diagnosis codes like H18.559 are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

Bedouin spastic ataxia syndrome
Bull's eye macular dystrophy
Bull's eye maculopathy
Congenital corneal dystrophy
Congenital macular corneal dystrophy
Hereditary macular dystrophy
Macular corneal dystrophy
Macular corneal dystrophy
Macular corneal dystrophy Type I
Macular corneal dystrophy Type II
Pattern dystrophy of macula
Retinal macular dystrophy type 2
Retinal pigment epithelial dystrophy

Clinical Classification

Clinical Category is Cornea and external disease
CCSR Category Code: EYE001
Inpatient Default CCSR: Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.
Outpatient Default CCSR: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

Clinical Information

Macular Corneal Dystrophy
a stromal corneal dystrophy, with autosomal recessive inheritance, that is caused by lack of or abnormal keratan sulfate.

H18.559 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
124	OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT	02	1.3219
125	OTHER DISORDERS OF THE EYE WITHOUT MCC	02	0.7975

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Replacement Code

H18559 replaces the following previously assigned ICD-10-CM code(s):

H18.55 - Macular corneal dystrophy

Code History

FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
FY 2021 - Code Added, effective from 10/1/2020 through 9/30/2021

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.