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H21.43

Billable

Pupillary membranes, bilateral

This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).

What This Code Means

This condition involves abnormal tissue membranes covering the pupil (the dark center of the eye) in both eyes. These membranes can affect vision by blocking or distorting light entry into the eye.

Coding Tips

  • Verify that the condition is documented as bilateral (affecting both eyes) before assigning this code; if only one eye is affected, use H21.41 or H21.42 instead
  • This code is typically used for congenital pupillary membranes or acquired membranes from inflammation or surgery; ensure the underlying cause is documented separately if relevant to treatment

Code Hierarchy

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