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H35.163

Billable

Retinopathy of prematurity, stage 5, bilateral

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

What This Code Means

The most severe stage of retinopathy of prematurity affecting both eyes, where the retinas have completely detached from the back of both eyes, typically resulting in permanent bilateral vision loss.

Coding Tips

  • •Stage 5 ROP in bilateral eyes indicates the worst prognosis; ensure documentation confirms both eyes are affected
  • •This represents the most severe form of ROP with highest risk of blindness

Code Hierarchy

└H35Other retinal disorders└H35.1Retinopathy of prematurity└H35.16Retinopathy of prematurity, stage 5└H35.163Retinopathy of prematurity, stage 5, bilateral
└H35.163Retinopathy of prematurity, stage 5, bilateral

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