2026 ICD-10-CM Diagnosis Code H35.343Macular cyst, hole, or pseudohole, bilateral
ICD-10-CM Codes›H00–H59›H30-H36›H35
- Billable — Valid for Submission
- Chronic Condition
H35.343 is a billable ICD-10-CM diagnosis code for macular cyst, hole, or pseudohole, bilateral. 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. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Retinal and vitreous conditions.
Code Identity
Code Classification
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Bilateral break of retina of eyes
- Bilateral full thickness hole of macula of eyes
- Bilateral macular hole of eyes
- Bilateral macular pseudohole of eyes
- Bilateral partial thickness macular hole of eyes
- Epiretinal membrane
- Epiretinal membrane of left eye
- Epiretinal membrane of right eye
- Full thickness hole of macula lutea
- Full thickness macular hole of left eye
- Full thickness macular hole of right eye
- Macular hole of left eye
- Macular hole of right eye
- Macular pseudohole
- Macular pseudohole of left eye
- Macular pseudohole of right eye
- Partial thickness macular hole
- Partial thickness macular hole of left eye
- Partial thickness macular hole of right eye
- Retinal macular break
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Epiretinal Membrane
a membrane on the vitreal surface of the retina resulting from the proliferation of one or more of three retinal elements: (1) fibrous astrocytes; (2) fibrocytes; and (3) retinal pigment epithelium. localized epiretinal membranes may occur at the posterior pole of the eye without clinical signs or may cause marked loss of vision as a result of covering, distorting, or detaching the fovea centralis. epiretinal membranes may cause vascular leakage and secondary retinal edema. in younger individuals some membranes appear to be developmental in origin and occur in otherwise normal eyes. the majority occur in association with retinal holes, ocular concussions, retinal inflammation, or after ocular surgery. (newell, ophthalmology: principles and concepts, 7th ed, p291)
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 H35.343 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About H35.343Overview
Is H35.343 (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, bilateral on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does H35.343 group to?
When macular cyst, hole, or pseudohole, bilateral 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 H35.343?
Under the General Equivalence Mappings, macular cyst, hole, or pseudohole, bilateral converts to ICD-9-CM 362.54 (macular cyst or hole). 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.
