Jul 2, 2024
Apr 15, 2025
Written By Elizabeth Cifers
While maculopathy can occur independently, it’s often a complication of another condition, genetic factor, or treatment. As a result of the many scenarios in which maculopathy can occur, there are various maculopathy-related International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes to choose from. Which one is correct for your coding needs now?
We can't provide a direct answer since we don’t know the specifics of what you’re coding for. However, we can offer a general discussion of maculopathy ICD-10 codes that hopefully point you in the right direction. Keep reading for a high-level overview of coding for maculopathy.
Have retina coding and billing questions? Get the specific answer you need. Ask retina coding and billing consultant Elizabeth Cifers here.
Maculopathy is a disorder or disease of the macula, the retina's center. Individuals with maculopathy slowly lose their central vision. Maculopathy is a progressive condition that typically presents in both eyes simultaneously (bilaterally) but can also occur in a single eye. It can be treated but not cured, at least not yet.
The most common type of maculopathy is age-related macular degeneration (ARMD or AMD), which typically affects people aged 50 and up. Other types include cellophane maculopathy or macular pucker, myopic maculopathy, and toxic maculopathy. Maculopathy can also be inherited or result from rare diseases or over-exposure to the sun.
Myopic maculopathy, or degenerative myopia, starts with a diagnosis of ‘high myopia,’ defined as a refractive error of -6.00 or greater or an axial length of 26.5mm or more. In addition to the high myopia diagnosis, there may be different pathologies also present, such as lacquer cracks or myopic choroidal neovascularization.¹ Toxic maculopathy results from the use of certain medications. In many instances, the damage can be reversed if the patient discontinues the use of the drug, but in other cases, the damage may be permanent.²
Many maculopathies are coded to H35 Other retinal disorders. Some examples include:
Toxic maculopathy is a small category comprising the code below with the appropriate eye designation, whether right, left, or bilateral. In addition, you should ‘code first’ the drug or toxin causing the maculopathy, if appropriate.
Myopic maculopathy or Degenerative myopia falls under H44.2XX Degenerative Myopia. A few examples are:
Please note that the codes above are included for illustrative purposes. The physician, or other qualified provider, is the only person who can diagnose the patient. Ensure the ICD-10 selected is representative of the chart documentation, and always choose the highest specificity for the ICD-10 code.3
Most physicians are aware of the different maculopathy diagnosis codes. However, if they are unaware that specific ICD-10 codes are available, you can point them in the right direction. Guiding the selection of the appropriate maculopathy diagnosis code falls outside the scope of an article like this. Still, the above discussion will steer your search for the correct code for your immediate needs.
If you regularly have questions about retina coding and billing nuances, consider partnering with retina practice consultant Elizabeth Cifers on coding and billing support. Elizabeth has decades of experience in coding and billing roles, including 13 years at a retina practice and a position at a leading eye care consulting firm. It doesn’t hurt to explore your options. You can book a free call to see if Elizabeth can assist with your unique challenges here.
Sources:
1Lauer, A. K., Sundy, M., Shah, V. A., Cui, R. Z., Hsu, J., & Lim, J. I. (2024, June 8). Pathologic Myopia (Myopic Degeneration). EyeWiki. https://eyewiki.org/Pathologic_Myopia_(Myopic_Degeneration)
2Chhablani, J., Shah, V. A., Tripathy, K., Zhu, I., Hsu, J., & Lim, J. I. (2023, December 23). Drug-Induced Maculopathy. EyeWiki. https://eyewiki.org/Drug_Induced_Maculopathy
3Find-A-Code (2024). Find-A-Code Comprehensive Search. Find-A-Code. https://www.findacode.com/index.html
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