2025 ICD-10-CM code H35.4

Peripheral retinal degeneration. It is a disorder affecting the outer edges of the retina.

Do not use H35.4 if the peripheral retinal degeneration is associated with a retinal break (H33.3-) or if it's a hereditary condition (H35.5-).

Medical necessity for services related to peripheral retinal degeneration is established by the presence of symptoms such as decreased peripheral vision, night vision problems, or the presence of degenerative changes in the peripheral retina.

In simple words: This refers to a deterioration of the tissue in the outer parts of your eye's retina, the light-sensitive layer at the back of your eye.

Peripheral retinal degeneration is a condition characterized by the breakdown of retinal tissue located at the periphery of the retina. It is distinct from hereditary retinal dystrophies and should not be confused with peripheral retinal degeneration accompanied by a retinal break.

Example 1: A 60-year-old patient presents with blurred peripheral vision and gradual loss of night vision. Upon examination, the ophthalmologist diagnoses peripheral retinal degeneration. Code H35.4 is used., A patient with a history of high myopia is found to have thinning of the peripheral retina during a routine eye exam. This is indicative of peripheral retinal degeneration, and H35.4 is applied., During a follow-up visit for lattice degeneration, a patient is found to have progressed to peripheral retinal degeneration without any retinal breaks. H35.4 is used to document the progression.

Documentation should include detailed ophthalmological findings, including visual field testing and retinal imaging, to support the diagnosis of peripheral retinal degeneration.

** Excludes1: hereditary retinal degeneration (dystrophy) (H35.5-) peripheral retinal degeneration with retinal break (H33.3-)Excludes2: 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)

  • Specialties:Ophthalmology
  • Place of Service:Office, Outpatient Hospital
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