H35.453 ICD-10-CM Code: Secondary pigmentary degeneration, bilateral
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)
H35.453
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSecondary pigmentary degeneration, bilateral
This condition involves the breakdown and loss of pigment in the light-sensitive tissue at the back of both eyes (retina), occurring as a result of another eye disease or condition. The pigment loss can affect vision and is present in both eyes.
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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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H35.453 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H35.453 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H35.453 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H35.453 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H35.453 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H35.453 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H35.453 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 H35.453 an HCC code?
No. H35.453 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
H35.453 is the ICD-10-CM diagnosis code for secondary pigmentary degeneration, bilateral. This condition involves the breakdown and loss of pigment in the light-sensitive tissue at the back of both eyes (retina), occurring as a result of another eye disease or condition. The pigment loss can affect vision and is present in both eyes. H35.453 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).
H35.453 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.
Verify that the pigmentary degeneration is documented as secondary (caused by another condition) rather than primary, and confirm bilateral involvement is documented in the medical record.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H35.453 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that the pigmentary degeneration is documented as secondary (caused by another condition) rather than primary, and confirm bilateral involvement is documented in the medical record
- •Investigate and code the underlying cause of the secondary degeneration if documented, as this provides more complete clinical information and may affect treatment decisions