2026 ICD-10-CM Diagnosis Code H35.169Retinopathy of prematurity, stage 5, unspecified eye

ICD-10-CM Codes›H00–H59›H30-H36›H35

ICD-10-CM H35.169
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

H35.169 is a billable ICD-10-CM diagnosis code for retinopathy of prematurity, stage 5, unspecified eye. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 124 through 125. Coders also document this condition as retinopathy of prematurity stage 5 - total retinal detachment. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Retinal and vitreous conditions.

Code Identity

ICD-10-CM Code
H35.169
Billable Status
Yes — Valid for Submission
Code Describes
Retinopathy of prematurity, stage 5, unspecified eye
Short Description
Retinopathy of prematurity, stage 5, unspecified eye
Same as the full description in the CMS dataset.
Parent Code
H35.16
Retinopathy of prematurity, stage 5

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH30-H36Disorders of choroid and retina
CategoryH35Other retinal disorders
This CodeH35.169Retinopathy of prematurity, stage 5, unspecified eye

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Retinopathy of prematurity stage 5 - total retinal detachment

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR EYE005
Retinal and vitreous conditions
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Premature Babies

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.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert H35.169 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
362.27 Retinoph prematr,stage 5
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About H35.169Overview

Is H35.169 (Retinopathy of prematurity, stage 5) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report retinopathy of prematurity, stage 5, unspecified eye on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does H35.169 group to?

When retinopathy of prematurity, stage 5, unspecified eye is the principal diagnosis on an inpatient stay, it groups to MS-DRG 124, 125, with relative weights from 0.7678 to 1.3231 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of H35.169?

Under the General Equivalence Mappings, retinopathy of prematurity, stage 5, unspecified eye converts to ICD-9-CM 362.27 (retinoph prematr,stage 5). The mapping is approximate, so confirm the match fits the documentation.

Footnotes

[1] Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:

  • The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
  • The condition places limitations on self-care, independent living, and social interactions.