H35.162 ICD-10-CM Code: Retinopathy of prematurity, stage 5, left eye
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)
H35.162
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceRetinopathy of prematurity, stage 5, left eye
The most severe stage of retinopathy of prematurity affecting the left eye, where the retina has completely detached from the back of the eye, typically resulting in permanent vision loss.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H35.162 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H35.162 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H35.162 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H35.162 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H35.162 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H35.162 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H35.162 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H35.162 an HCC code?
No. H35.162 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H35.162 is the ICD-10-CM diagnosis code for retinopathy of prematurity, stage 5, left eye. The most severe stage of retinopathy of prematurity affecting the left eye, where the retina has completely detached from the back of the eye, typically resulting in permanent vision loss. H35.162 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of choroid and retina (h30-h36).
H35.162 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Stage 5 ROP represents total retinal detachment and is the most advanced stage; document carefully.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H35.162 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Stage 5 ROP represents total retinal detachment and is the most advanced stage; document carefully
- •Confirm left eye involvement is explicitly stated in the clinical documentation