2025 ICD-10-CM code H35.52
(Valid) Effective Date: N/A Diseases of the eye and adnexa - Hereditary retinal dystrophies 7 Feed
Pigmentary retinal dystrophy, a genetic eye disease causing progressive vision loss.
The medical necessity for services related to H35.52 stems from the progressive and potentially debilitating nature of pigmentary retinal dystrophy. Medical intervention is necessary to monitor disease progression, manage complications like macular edema or cataracts, provide low vision rehabilitation services, and offer genetic counseling to patients and their families.
Diagnosis and management of pigmentary retinal dystrophy typically falls under the purview of ophthalmologists, specialists in eye diseases.They are responsible for confirming the diagnosis through clinical examination, including ophthalmoscopy and visual field testing, sometimes complemented by electroretinography (ERG) and genetic testing. Ophthalmologists also advise patients on the prognosis, potential complications (such as cataracts and macular edema), and low vision aids.
In simple words: This is an inherited eye disease where the cells that help you see gradually stop working. It usually starts with difficulty seeing at night and can lead to loss of side vision and sometimes even central vision over time.
Pigmentary retinal dystrophy (also known as retinitis pigmentosa) is a group of inherited disorders characterized by the progressive degeneration of photoreceptor cells (rods and cones) in the retina, often accompanied by retinal pigment epithelium (RPE) cell degeneration.The condition leads to a gradual loss of vision, typically starting with night blindness and progressing to peripheral vision loss, and in some cases, central vision impairment. Although the term "retinitis" suggests inflammation, this is not a prominent feature of the disease.
Example 1: A 25-year-old patient presents with difficulty seeing in low light conditions and reports a family history of vision loss. Upon examination, the ophthalmologist notes bone spicule-like pigment deposits in the retina and attenuated retinal arterioles, characteristic of retinitis pigmentosa. The diagnosis is confirmed with ERG, and the patient is coded with H35.52., A 40-year-old with known retinitis pigmentosa experiences increasing difficulty with central vision. Examination reveals macular edema, a complication of the disease. The patient receives treatment for the edema and is coded with H35.52 for the underlying condition and the appropriate code for macular edema., A child exhibits delayed visual development and is referred to an ophthalmologist. Diagnostic tests reveal retinal dystrophy consistent with retinitis pigmentosa. Genetic testing confirms the diagnosis, and the child is coded with H35.52.
Documentation for H35.52 should include details of the ophthalmological examination (e.g., fundus findings, visual field assessment), results of diagnostic tests like ERG, and if available, genetic testing confirmation. Family history of similar conditions should also be documented. Any associated symptoms or complications, such as cataracts, macular edema, or visual disturbances, should be documented as well.
- Specialties:Ophthalmology, Optometry, Genetics
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital (if complications require hospitalization)