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H35.3231 ICD-10-CM Code: Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization

Compare with another codeCheck this code on a claim

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

7th character
Required — see the character table on this page
Tabular directives
1 Excludes2
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 124

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too; the Instructions section marks which is which.

Excludes2Not included here; may be reported together
  • diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)

CompareCheck ClaimView Related Codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 124 — OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT (MDC 02)
  • MS-DRG 125 — OTHER DISORDERS OF THE EYE WITHOUT MCC (MDC 02)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 300 — Exudative Macular Degeneration

Other models: CMS-HCC V22 HCC 124

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for H35.3231 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on H35.3231 itself; “inherited from” names the category or block whose note applies here.

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from H35

7th Character Guide

"One of the following 7th characters is to be assigned to codes in subcategory H35.32 to designate the stage of the disease:"

  • 0 — stage unspecified
  • 1 — with active choroidal neovascularization (this page’s code)
  • 2 — with inactive choroidal neovascularization
  • 3 — with inactive scar

Variant codes in this family

H35.3230, H35.3231, H35.3232, H35.3233

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for H35.3231

MedCoder structured workflow — derived from this code’s own official record

Before you code H35.3231

  1. A 7th character is required in this family. Confirm the documentation supports the character assigned — its meaning in this family is defined in the official instruction. This page’s code carries “1”. The official 7th-character definitions for this family are quoted in the guide.

    See the 7th Character Guide

  2. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: bilateral). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

    See the relationships section · Guide: Laterality coding →

  3. H35.3231’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

Choose the right path

  1. Is the side documented?
    Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
    No → Use the unspecified-side code only when the record states no side; a query is the alternative.
  2. Does the documentation support one of this family’s 7th-character values?
    Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
    No → The code is invalid without its 7th character — query for the missing element.

Consider H35.3231. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Laterality
Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).
7th-character basis
The documented element this family’s 7th character records (see the official definitions in the 7th Character Guide).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).

Official instructions as workflow

  • Excludes2 — not part of H35.3231(1 note)

    Coding workflow: The conditions named in this note are not included in H35.3231. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The record documents the condition on one side only.

Coding question: Which code in this family applies?

Path: Select the sibling code for the documented side.

Reason: Laterality is assigned from the documented side; the unspecified-side code is for records that state no side (Guidelines I.B.13).

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is H35.3231 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse H35.3231 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of H35.3231 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • H35.3230— Specificity relationship (Review)

    Overlapping diagnoses in the same category.

    Overlapping codes in the same category — the documentation decides which is the more specific fit.

    What moves you there: A record that documents no more than “Exudative age-related macular degeneration, bilateral, stage unspecified” takes H35.3230; specificity in the record moves it back here.

    Full comparison: H35.3231 vs H35.3230 →

  • H35.3232— Encounter relationship (Review)

    Same underlying diagnosis, different encounter phase.

    The same diagnosis at a different phase of care; one encounter takes one 7th character.

    What moves you there: Documentation of a with inactive choroidal neovascularization moves the case to H35.3232.

    Full comparison: H35.3231 vs H35.3232 →

  • H35.3233— Encounter relationship (Review)

    Same underlying diagnosis, different encounter phase.

    The same diagnosis at a different phase of care; one encounter takes one 7th character.

    What moves you there: Documentation of a with inactive scar moves the case to H35.3233.

    Full comparison: H35.3231 vs H35.3233 →

  • E08.311— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of diabetic retinal disorders adds E08.311; it is not part of this code and both may be reported when both are documented.

    Full comparison: H35.3231 vs E08.311 →

  • E08.359— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of diabetic retinal disorders adds E08.359; it is not part of this code and both may be reported when both are documented.

    Full comparison: H35.3231 vs E08.359 →

  • E09.311— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of diabetic retinal disorders adds E09.311; it is not part of this code and both may be reported when both are documented.

    Full comparison: H35.3231 vs E09.311 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization is a billable ICD-10-CM diagnosis code (H35.3231).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
  2. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
  3. 1 Excludes2 entry — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • Age-restricted: the Medicare Code Editor lists this as an adult (age 15-124) diagnosis; other ages are presumed incorrect.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder-derived relationships — computed from published CMS and AHRQ datasets

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 2 MS-DRGs: DRG 124 (MDC 02), DRG 125 (MDC 02).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):EYE005 — Retinal and vitreous conditions (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Exudative Macular Degeneration) for risk-adjusted payment.

H35.3210 — Exudative age-related macular degeneration, right eye, stage unspecified, H35.3211 — Exudative age-related macular degeneration, right eye, with active choroidal neovascularization, H35.3212 — Exudative age-related macular degeneration, right eye, with inactive choroidal neovascularization, H35.3213 — Exudative age-related macular degeneration, right eye, with inactive scar, H35.3220 — Exudative age-related macular degeneration, left eye, stage unspecified, H35.3221 — Exudative age-related macular degeneration, left eye, with active choroidal neovascularization, H35.3222 — Exudative age-related macular degeneration, left eye, with inactive choroidal neovascularization, H35.3223 — Exudative age-related macular degeneration, left eye, with inactive scar, H35.3230 — Exudative age-related macular degeneration, bilateral, stage unspecified, H35.3232 — Exudative age-related macular degeneration, bilateral, with inactive choroidal neovascularization, H35.3233 — Exudative age-related macular degeneration, bilateral, with inactive scar, H35.3290 — Exudative age-related macular degeneration, unspecified eye, stage unspecified, H35.3291 — Exudative age-related macular degeneration, unspecified eye, with active choroidal neovascularization, H35.3292 — Exudative age-related macular degeneration, unspecified eye, with inactive choroidal neovascularization, H35.3293 — Exudative age-related macular degeneration, unspecified eye, with inactive scar

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Retinal and vitreous conditions).

+747 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Degeneration, degenerative”; these codes share that main term but sit in a different category of the Tabular List.

H18.43 — Other calcerous corneal degeneration (cornea, calcerous), H18.45 — Nodular corneal degeneration (cornea, nodular), H18.46 — Peripheral corneal degeneration (cornea, peripheral), H18.49 — Other corneal degeneration (cornea, hyaline), H21.21 — Degeneration of chamber angle (chamber angle), H21.22 — Degeneration of ciliary body (ciliary body), H21.23 — Degeneration of iris (pigmentary) (iris), H21.24 — Degeneration of pupillary margin (pupillary margin), H31.10 — Unspecified choroidal degeneration (choroid), H31.20 — Hereditary choroidal dystrophy, unspecified (chorioretinal, hereditary), H43.81 — Vitreous degeneration (vitreous), I01.2 — Acute rheumatic myocarditis (myocardial, myocardium, with rheumatic fever, active, acute or subacute), I02.0 — Rheumatic chorea with heart involvement (myocardial, myocardium, with rheumatic fever, active, acute or subacute, with chorea), I07.9 — Rheumatic tricuspid valve disease, unspecified (tricuspid), I09.0 — Rheumatic myocarditis (myocardial, myocardium, with rheumatic fever), I37.8 — Other nonrheumatic pulmonary valve disorders (pulmonary valve), I51.5 — Myocardial degeneration (myocardial, myocardium), I67.2 — Cerebral atherosclerosis (brain, arteriosclerotic), I67.4 — Hypertensive encephalopathy (cerebrovascular, due to hypertension), I67.9 — Cerebrovascular disease, unspecified (cerebrovascular), +103 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Blood Glucose Test

Contextual Map

Every relationship of H35.3231 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 300 — Exudative Macular Degeneration [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 02 — Diseases and Disorders of the Eye[MDC crossing]: “Diseases and Disorders of the Eye — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,200 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Nearest codes (40)

Change history

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Common coding questions

MedCoder editorial

Does H35.3231 require a 7th character?

Yes. One of the following 7th characters is to be assigned to codes in subcategory H35.32 to designate the stage of the disease:.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "H35.3231 — Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/h35.3231-exudative-age-related-macular-degeneration-bilateral-with-active-choroidal-neovascularization

Change history

  • FY2017 — October 1, 2016
    Added to the code set
    Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization
    FY2017 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to H35.3231 in its code family, with their registry titles.

View all codes in the H35 family