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    OpenPayerBilling CodesDisorders of choroid and retinaICD-10-CM h36-retinal-disorders-in-diseases-classified-elsewhere
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    ICD-10-CM Code For Retinal Disorders In Diseases Classified Elsewhere: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group H36 includes retinal disorders that arise as complications of systemic diseases, such as diabetic retinopathy and other vascular or inflammatory conditions affecting the retina. These ICD-10-CM diagnosis codes are used to document ocular complications of systemic disease, capturing disease severity, organ involvement, and clinical complexity relevant to retinal manifestations. Accurate coding within the ICD-10-CM H36 group supports proper claim adjudication, complete clinical documentation, and appropriate reimbursement.

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    ICD-10-CM H36: Retinal Disorders In Diseases Classified Elsewhere Overview

    The ICD-10-CM H36 group captures retinal disorders that occur as manifestations of systemic diseases classified in other chapters, such as diabetic retinopathy. These diagnoses target the retina and its vasculature and are important for documenting ocular complications of systemic conditions. Accurate coding is important for complete clinical records and supports appropriate reimbursement by reflecting the relationship between the retinal condition and the underlying disease.

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    When to Use

    Use a code from this group when a retinal disorder is documented as a manifestation of a systemic disease and the clinical record links the ocular finding to the underlying condition. Select the code that reflects the specific retinal diagnosis, laterality, and severity as documented in the medical record.

    ICD-10-CM Codes

    9 rows

    ICD-10-CM CodeDescription
    H36.811Nonproliferative sickle-cell retinopathy, right eye
    H36.812Nonproliferative sickle-cell retinopathy, left eye
    H36.813Nonproliferative sickle-cell retinopathy, bilateral
    H36.819Nonproliferative sickle-cell retinopathy, unspecified eye
    H36.821Proliferative sickle-cell retinopathy, right eye
    H36.822Proliferative sickle-cell retinopathy, left eye
    H36.823Proliferative sickle-cell retinopathy, bilateral
    H36.829Proliferative sickle-cell retinopathy, unspecified eye
    H36.89Other retinal disorders in diseases classified elsewhere

    DRG Codes

    2 rows

    DRG CodeDescription
    124Other Disorders of the Eye with MCC or Thrombolytic Agent
    125Other Disorders of the Eye without MCC

    Typical Clinical Scenarios

    • A 68-year-old patient with long-standing type 2 diabetes presents with progressive painless central vision blurring and metamorphopsia in one eye over several weeks. Fundus exam and OCT demonstrate macular edema with intraretinal cysts and hard exudates consistent with diabetic macular edema as a manifestation of diabetes mellitus; a code from this group is assigned to capture the retinal disorder occurring in diabetes. Typical codes: H36.811, H36.812
    • A 55-year-old patient with hypertension and chronic renal disease is seen in clinic for routine ophthalmic follow-up and is found to have scattered retinal microaneurysms, dot-blot hemorrhages, and mild macular thickening without acute vision loss; this represents chronic background diabetic retinopathy with macular involvement being monitored. A code from this group is used to document the retinal findings related to the systemic disease as an ongoing, chronic condition affecting vision. Typical codes: H36.821, H36.822
    • A 42-year-old pregnant patient presents to the emergency department with sudden onset of floaters and a partial loss of peripheral vision in one eye; exam reveals vitreous hemorrhage and proliferative neovascularization of the retina secondary to diabetes. An acute complication of proliferative disease is coded from this group to indicate the neovascular retinal disorder in the setting of systemic disease requiring urgent ophthalmic management. Typical codes: H36.813, H36.823

    Related Codes

    H30-CHORIORETINAL-INFLAMMATION

    ICD-10-CM Code For Chorioretinal Inflammation: Group Overview

    H31-OTHER-DISORDERS-OF-CHOROID

    ICD-10-CM Code For Other Disorders Of Choroid: Group Overview

    H32-CHORIORETINAL-DISORDERS-SECONDARY

    ICD-10-CM Code For Chorioretinal Disorders In Diseases Classified Elsewhere: Group Overview

    H33-RETINAL-DETACHMENTS-AND-BREAKS

    ICD-10-CM Code For Retinal Detachments And Breaks: Group Overview

    H34-RETINAL-VASCULAR-OCCLUSIONS

    ICD-10-CM Code For Retinal Vascular Occlusions: Group Overview

    H35-OTHER-RETINAL-DISORDERS

    ICD-10-CM Code For Other Retinal Disorders: Group Overview

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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