2026 ICD-10-CM Diagnosis Code H35.81Retinal edema

ICD-10-CM Codes›H00–H59›H30-H36›H35

ICD-10-CM H35.81
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

H35.81 is a billable ICD-10-CM diagnosis code for retinal edema. 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

ICD-10-CM Code
H35.81
Billable Status
Yes — Valid for Submission
Code Describes
Retinal edema
Short Description
Retinal edema
Same as the full description in the CMS dataset.
Parent Code
H35.8
Other specified retinal disorders

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH30-H36Disorders of choroid and retina
CategoryH35Other retinal disorders
This CodeH35.81Retinal edema

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Autosomal dominant cystoid macular edema
  • Bilateral cystoid macular edema of retinas
  • Clinically significant macular edema
  • Cotton wool spots
  • Cystoid macular edema
  • Cystoid macular edema of left retina
  • Cystoid macular edema of right retina
  • Localized edema
  • Localized retinal edema
  • Macular edema of retina of bilateral eyes
  • Macular edema of retina of left eye
  • Macular edema of retina of right eye
  • Macular retinal edema
  • Noncystoid edema of macula of retina
  • Peripheral retinal edema
  • Retinal edema
  • Uveitis related cystoid macular edema
  • Widespread retinal edema

Tabular List NotesGuidance

Coding notes and annotation back-references applicable to this code.

Inclusion Terms

  • Retinal cotton wool spots

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

External Cause of Injuries IndexGuidance

References for this code in the External Cause of Injuries Index.

    • Congestion, congestive
      • retina
    • Cotton wool spots(retinal)
    • Disorder(of)
      • retina
        • edema
    • Edema, edematous(infectious) (pitting) (toxic)
      • macula
    • Edema, edematous(infectious) (pitting) (toxic)
      • retina

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

Clinical InformationClinical

  • Cystoid Macular Edema

    an accumulation of fluid in the outer plexiform layer, secondary to an increase in permeability of perifoveal retinal capillaries.

Patient EducationClinical

Retinal Disorders

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.

Read the full article at MedlinePlus

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

Convert H35.81 to ICD-9-CMHistory

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

ICD-9-CM
362.83 Retinal edema
Exact Match The mapping is direct, with no qualifiers.

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 H35.81Overview

Is H35.81 (Other specified retinal disorders) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report retinal edema on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does H35.81 group to?

When retinal edema 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 H35.81?

Under the General Equivalence Mappings, retinal edema converts to ICD-9-CM 362.83 (retinal edema). The mapping is a direct match.

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.