H35.3113 is a billable diagnosis code used to specify a medical diagnosis of nonexudative age-related macular degeneration, right eye, advanced atrophic without subfoveal involvement. The code H35.3113 is valid during the fiscal year 2022 from October 01, 2021 through September 30, 2022 for the submission of HIPAA-covered transactions.
The code H35.3113 is applicable to adult patients aged 15 through 124 years inclusive. It is clinically and virtually impossible to use this code on a patient outside the stated age range.
The code H35.3113 is linked to some Quality Measures as part of Medicare's Quality Payment Program (QPP). When this code is used as part of a patient's medical record the following Quality Measures might apply: Age-related Macular Degeneration (amd): Dilated Macular Examination.
The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 Code Edits are applicable to this code:
Diagnostic Related Groups - MS-DRG Mapping
|MS-DRG||MS-DRG Title||MCD||Relative Weight|
|124||OTHER DISORDERS OF THE EYE WITH MCC||02||1.3988|
|125||OTHER DISORDERS OF THE EYE WITHOUT MCC||02||0.8354|
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.
H353113 replaces the following previously assigned ICD-10 code(s):
Convert H35.3113 to ICD-9 Code
The General Equivalency Mapping (GEM) crosswalk indicates an approximate mapping between the ICD-10 code H35.3113 its ICD-9 equivalent. The approximate mapping means there is not an exact match between the ICD-10 code and the ICD-9 code and the mapped code is not a precise representation of the original code.
Quality Payment Program Measures
When code H35.3113 is part of the patient's diagnoses the following Quality Measures apply and affect reimbursement. The objective of Medicare's Quality Measures is to improve patient care by making it more: effective, safe, efficient, patient-centered and equitable.
|Quality Measure||Description||Quality Domain||Measure Type||High Priority||Submission Methods|
|Age-Related Macular Degeneration (AMD): Dilated Macular Examination||Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND the level of macular degeneration severity during one or more office visits within the 12 month performance period.||Effective Clinical Care||Process||NO||Claims, Registry|
Information for Patients
Macular degeneration, or age-related macular degeneration (AMD), is a leading cause of vision loss in Americans 60 and older. It is a disease that destroys your sharp, central vision. You need central vision to see objects clearly and to do tasks such as reading and driving.
AMD affects the macula, the part of the eye that allows you to see fine detail. It does not hurt, but it causes cells in the macula to die. There are two types: wet and dry. Wet AMD happens when abnormal blood vessels grow under the macula. These new blood vessels often leak blood and fluid. Wet AMD damages the macula quickly. Blurred vision is a common early symptom. Dry AMD happens when the light-sensitive cells in the macula slowly break down. Your gradually lose your central vision. A common early symptom is that straight lines appear crooked.
Regular comprehensive eye exams can detect macular degeneration before the disease causes vision loss. Treatment can slow vision loss. It does not restore vision.
NIH: National Eye Institute
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|ICD Code||Description||Valid for Submission|
|H35||Other retinal disorders||NON-BILLABLE CODE|
|H35.0||Background retinopathy and retinal vascular changes||NON-BILLABLE CODE|
|H35.00||Unspecified background retinopathy||BILLABLE CODE|
|H35.01||Changes in retinal vascular appearance||NON-BILLABLE CODE|
|H35.011||Changes in retinal vascular appearance, right eye||BILLABLE CODE|
|H35.012||Changes in retinal vascular appearance, left eye||BILLABLE CODE|
|H35.013||Changes in retinal vascular appearance, bilateral||BILLABLE CODE|
|H35.019||Changes in retinal vascular appearance, unspecified eye||BILLABLE CODE|
|H35.02||Exudative retinopathy||NON-BILLABLE CODE|
|H35.021||Exudative retinopathy, right eye||BILLABLE CODE|
|H35.022||Exudative retinopathy, left eye||BILLABLE CODE|
|H35.023||Exudative retinopathy, bilateral||BILLABLE CODE|
|H35.029||Exudative retinopathy, unspecified eye||BILLABLE CODE|
|H35.03||Hypertensive retinopathy||NON-BILLABLE CODE|
|H35.031||Hypertensive retinopathy, right eye||BILLABLE CODE|
|H35.032||Hypertensive retinopathy, left eye||BILLABLE CODE|
|H35.033||Hypertensive retinopathy, bilateral||BILLABLE CODE|
|H35.039||Hypertensive retinopathy, unspecified eye||BILLABLE CODE|
|H35.04||Retinal micro-aneurysms, unspecified||NON-BILLABLE CODE|
|H35.041||Retinal micro-aneurysms, unspecified, right eye||BILLABLE CODE|
|H35.042||Retinal micro-aneurysms, unspecified, left eye||BILLABLE CODE|
|H35.043||Retinal micro-aneurysms, unspecified, bilateral||BILLABLE CODE|
|H35.049||Retinal micro-aneurysms, unspecified, unspecified eye||BILLABLE CODE|
|H35.05||Retinal neovascularization, unspecified||NON-BILLABLE CODE|
|H35.051||Retinal neovascularization, unspecified, right eye||BILLABLE CODE|
|H35.052||Retinal neovascularization, unspecified, left eye||BILLABLE CODE|
|H35.053||Retinal neovascularization, unspecified, bilateral||BILLABLE CODE|
|H35.059||Retinal neovascularization, unspecified, unspecified eye||BILLABLE CODE|
|H35.06||Retinal vasculitis||NON-BILLABLE CODE|
|H35.061||Retinal vasculitis, right eye||BILLABLE CODE|
|H35.062||Retinal vasculitis, left eye||BILLABLE CODE|
|H35.063||Retinal vasculitis, bilateral||BILLABLE CODE|
|H35.069||Retinal vasculitis, unspecified eye||BILLABLE CODE|
|H35.07||Retinal telangiectasis||NON-BILLABLE CODE|
|H35.071||Retinal telangiectasis, right eye||BILLABLE CODE|
|H35.072||Retinal telangiectasis, left eye||BILLABLE CODE|
|H35.073||Retinal telangiectasis, bilateral||BILLABLE CODE|
|H35.079||Retinal telangiectasis, unspecified eye||BILLABLE CODE|
|H35.09||Other intraretinal microvascular abnormalities||BILLABLE CODE|
|H35.1||Retinopathy of prematurity||NON-BILLABLE CODE|
|H35.10||Retinopathy of prematurity, unspecified||NON-BILLABLE CODE|
|H35.101||Retinopathy of prematurity, unspecified, right eye||BILLABLE CODE|
|H35.102||Retinopathy of prematurity, unspecified, left eye||BILLABLE CODE|
|H35.103||Retinopathy of prematurity, unspecified, bilateral||BILLABLE CODE|
|H35.109||Retinopathy of prematurity, unspecified, unspecified eye||BILLABLE CODE|
|H35.11||Retinopathy of prematurity, stage 0||NON-BILLABLE CODE|
|H35.111||Retinopathy of prematurity, stage 0, right eye||BILLABLE CODE|
|H35.112||Retinopathy of prematurity, stage 0, left eye||BILLABLE CODE|
|H35.113||Retinopathy of prematurity, stage 0, bilateral||BILLABLE CODE|
|H35.119||Retinopathy of prematurity, stage 0, unspecified eye||BILLABLE CODE|
|H35.12||Retinopathy of prematurity, stage 1||NON-BILLABLE CODE|