H35.1 is a non-specific and non-billable ICD-10 code code, consider using a code with a higher level of specificity for a diagnosis of retinopathy of prematurity. The code is not specific and is NOT valid for the year 2023 for the submission of HIPAA-covered transactions. Category or Header define the heading of a category of codes that may be further subdivided by the use of 4th, 5th, 6th or 7th characters.
- Retinopathy of Prematurity-. a bilateral retinopathy occurring in premature infants treated with excessively high concentrations of oxygen, characterized by vascular dilatation, proliferation, and tortuosity, edema, and retinal detachment, with ultimate conversion of the retina into a fibrous mass that can be seen as a dense retrolental membrane. usually growth of the eye is arrested and may result in microophthalmia, and blindness may occur. (dorland, 27th ed)
Specific Coding for Retinopathy of prematurity
Non-specific codes like H35.1 require more digits to indicate the appropriate level of specificity. Consider using any of the following ICD-10 codes with a higher level of specificity when coding for retinopathy of prematurity:
Almost 1 of every 10 infants born in the United States are premature, or preemies. A premature birth is when a baby is born before 37 completed weeks of pregnancy. A full-term pregnancy is 40 weeks.
Important growth and development happen throughout pregnancy - especially in the final months and weeks. Because they are born too early, preemies weigh much less than full-term babies. They may have health problems because their organs did not have enough time to develop. Problems that a baby born too early may have include:
- Breathing problems
- Feeding difficulties
- Cerebral palsy
- Developmental delay
- Vision problems
- Hearing problems
Preemies need special medical care in a neonatal intensive care unit, or NICU. They stay there until their organ systems can work on their own.
Centers for Disease Control and Prevention
[Learn More in MedlinePlus]
The retina is a layer of tissue in the back of your eye that senses light and sends images to your brain. In the center of this nerve tissue is the macula. It provides the sharp, central vision needed for reading, driving and seeing fine detail.
Retinal disorders affect this vital tissue. They can affect your vision, and some can be serious enough to cause blindness. Examples are:
- Macular degeneration - a disease that destroys your sharp, central vision
- Diabetic eye disease
- Retinal detachment - a medical emergency, when the retina is pulled away from the back of the eye
- Retinoblastoma - cancer of the retina. It is most common in young children.
- Macular pucker - scar tissue on the macula
- Macular hole - a small break in the macula that usually happens to people over 60
- Floaters - cobwebs or specks in your field of vision
NIH: National Eye Institute
[Learn More in MedlinePlus]
- 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 - No Change, effective from 10/1/2020 through 9/30/2021
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
- FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
- FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
- FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)