Facebook tracking pixel
H35.379
ICD-10-CM
Preretinal Fibrosis

Understand Preretinal Fibrosis with this guide to clinical documentation and medical coding. Learn about diagnosis, symptoms, ICD-10 codes (H35.04), treatment options, and differential diagnosis for Preretinal Membrane, Cellophane Maculopathy, and Epiretinal Membrane. Find resources for healthcare professionals, including accurate medical coding for billing and insurance purposes. Explore information on macular pucker, vitreous detachment, and other related eye conditions for comprehensive patient care.

Also known as

Epiretinal Membrane
Macular Pucker

Diagnosis Snapshot

Key Facts
  • Definition : Scar tissue formation in front of the retina, often caused by abnormal blood vessel growth.
  • Clinical Signs : Blurred vision, distorted vision, visual field loss, and sometimes no symptoms.
  • Common Settings : Ophthalmology clinics, retina specialists, and hospital eye departments.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC H35.379 Coding
H35.0-

Preretinal macular fibrosis

Covers preretinal fibrosis specifically affecting the macula.

H35.8-

Other retinal disorders

Includes other specified retinal disorders when a more specific code isn't available.

H43.1-

Vitreous prolapse

May be related to preretinal fibrosis as vitreous traction can contribute.

H25.0-

Senile posterior cortical cataract

Sometimes associated with preretinal fibrosis due to posterior segment changes.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the preretinal fibrosis associated with proliferative diabetic retinopathy?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Preretinal membrane distorting vision.
Epiretinal membrane on retinal surface.
Vitreomacular traction pulling on macula.

Documentation Best Practices

Documentation Checklist
  • Preretinal fibrosis diagnosis documented
  • Detailed retinal exam findings (e.g., cellophane macular reflex)
  • Symptoms impacting vision (e.g., metamorphopsia, blurred vision)
  • Epiretinal membrane location and extent specified
  • Associated conditions (e.g., PVD, diabetic retinopathy) noted

Coding and Audit Risks

Common Risks
  • Unspecified Laterality

    Coding lacks right/left eye specificity, impacting reimbursement and data analysis. CDI should query for laterality documentation.

  • Unclear Etiology

    Missing documentation of underlying cause (e.g., age-related macular degeneration) can affect accurate code assignment and quality metrics.

  • Stage Miscoding

    Inaccurate coding of fibrosis severity (e.g., macular pucker vs. epiretinal membrane) can lead to incorrect billing and skewed outcomes data.

Mitigation Tips

Best Practices
  • Timely dilated eye exams, ICD-10 H35.0, optimize CDI for accurate coding.
  • Document detailed fundus exam, preretinal fibrosis stage, impacting HCC risk adjustment.
  • Anti-VEGF therapy for active neovascularization, track response for compliance audits.
  • Control systemic conditions like hypertension, diabetes for optimal fibrosis management.
  • Patient education on disease progression, low vision aids, ensuring compliance, ICD-10 H54

Clinical Decision Support

Checklist
  • Confirm cellophane macular reflex on funduscopy
  • Verify presence of preretinal fibrosis on OCT
  • Document premacular fibrosis, epiretinal membrane
  • Exclude other causes of decreased vision
  • Assess impact on visual acuity, document Amsler grid findings

Reimbursement and Quality Metrics

Impact Summary
  • Preretinal Fibrosis Reimbursement: ICD-10-CM H35.1, optimize coding for accurate claims, maximize revenue.
  • Quality Metrics Impact: Monitor Preretinal Fibrosis diagnosis coding accuracy for proper hospital quality reporting.
  • Coding Accuracy: Precise H35.1 coding impacts RAF scores, hierarchical condition categories (HCCs) and risk adjustment.
  • Hospital Reporting: Accurate Preretinal Fibrosis coding improves data integrity for public health reporting and resource allocation.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code H35.02 for Preretinal Fibrosis
  • Document macular pucker if present
  • Specify laterality (OD, OS, OU)
  • Consider underlying cause codes
  • Query MD for epiretinal membrane detail

Documentation Templates

Preretinal fibrosis, also known as cellophane maculopathy or surface wrinkling retinopathy, was diagnosed in this patient.  The patient presented with complaints of metamorphopsia and mild blurring of vision in the affected eye.  Visual acuity was [insert visual acuity, e.g., 20/40] in the right eye and [insert visual acuity, e.g., 20/25] in the left eye.  Funduscopic examination revealed a delicate, glistening, semitransparent membrane on the inner surface of the retina, consistent with preretinal fibrosis.  Optical coherence tomography (OCT) confirmed the presence of a thin, hyperreflective membrane anterior to the retina without significant retinal traction or distortion.  Fluorescein angiography showed no leakage.  Differential diagnosis included epiretinal membrane, macular pucker, and vitreomacular traction syndrome.  The patient's symptoms are currently mild and stable.  Management at this time consists of observation and monitoring for progression.  Patient education regarding the natural history of preretinal fibrosis and potential complications such as macular edema or retinal detachment was provided.  Follow-up examination in [insert timeframe, e.g., 3-6 months] is recommended to assess for any changes in visual acuity or retinal status.  ICD-10 code H35.31 (Preretinal macular fibrosis) is applicable.