H21.42
BillablePupillary membranes, left eye
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
An abnormal membrane or tissue growth covering the pupil (the dark center of the eye) in the left eye. This can affect vision by blocking light from entering the eye properly.
Coding Tips
- •Verify documentation specifies 'left eye' to ensure correct laterality coding; if bilateral, code both H21.41 (right) and H21.42 (left)
- •Confirm whether this is congenital, acquired, or post-surgical in origin, as this may affect medical necessity and treatment decisions
Code Hierarchy
└H21Other disorders of iris and ciliary body└H21.4Pupillary membranes└H21.42Pupillary membranes, left eye
└H21.42Pupillary membranes, left eye