2027 ICD-10-CM Diagnosis Code H35.342Macular cyst, hole, or pseudohole, left eye

ICD-10-CM Codes›H00–H59›H30-H36›H35

ICD-10-CM H35.342
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

H35.342 is a billable ICD-10-CM diagnosis code for macular cyst, hole, or pseudohole, left eye. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 124 through 125. Coders also document this condition as epiretinal membrane. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Retinal and vitreous conditions.

Code Identity

ICD-10-CM Code
H35.342
Billable Status
Yes — Valid for Submission
Code Describes
Macular cyst, hole, or pseudohole, left eye
Short Description
Macular cyst, hole, or pseudohole, left eye
Same as the full description in the CMS dataset.
Parent Code
H35.34
Macular cyst, hole, or pseudohole

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH30-H36Disorders of choroid and retina
CategoryH35Other retinal disorders
This CodeH35.342Macular cyst, hole, or pseudohole, left eye

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Epiretinal membrane
  • Epiretinal membrane of left eye
  • Full thickness hole of macula lutea
  • Full thickness macular hole of left eye
  • Macular hole of left eye
  • Macular pseudohole
  • Macular pseudohole of left eye
  • Partial thickness macular hole
  • Partial thickness macular hole of left eye
  • Retinal macular break

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to H35.342: its own notes plus those printed at H35 and Chapter 7. A note printed at a category, block or chapter applies to every code under it.

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From H35 Other retinal disorders applies to 175 codes
From Chapter 7 (H00-H59) Diseases of the eye and adnexa applies to 2,677 codes
  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
  • diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury (trauma) of eye and orbit (S05.-)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
  • syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)

Notes

General instructions on how these codes are used.

From Chapter 7 (H00-H59) Diseases of the eye and adnexa applies to 2,677 codes
  • Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

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

Macular Degeneration

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.

Read the full article at MedlinePlus

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

Convert H35.342 to ICD-9-CMHistory

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

ICD-9-CM
362.54 Macular cyst or hole
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 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About H35.342Overview

What is the ICD-10 code for macular cyst, hole, or pseudohole, left eye?

The ICD-10-CM code for macular cyst, hole, or pseudohole, left eye is H35.342 (sometimes written as H35342). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is H35.342 (Macular cyst, hole, or pseudohole) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report macular cyst, hole, or pseudohole, left eye on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does H35.342 group to?

When macular cyst, hole, or pseudohole, left eye is the principal diagnosis on an inpatient stay, it groups to MS-DRG 125, 124, with relative weights from 0.7699 to 1.2470 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of H35.342?

Under the General Equivalence Mappings, macular cyst, hole, or pseudohole, left eye converts to ICD-9-CM 362.54 (macular cyst or hole). The mapping is approximate, so confirm the match fits the documentation.