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H35.38 ICD-10-CM Code: Toxic maculopathy

Compare with another code for H35.38Check this code on a claim

Billing Status: NO. This is a non-billable ICD-10-CM code: report a more specific billable code beneath it.

Coding at a Glance

Official instructions
1 Excludes2 · 1 use-additional instruction · 1 code-first instruction

What these terms mean →

Not billable · FY2027A non-billable heading in the tabular list: report a more specific code beneath it.

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, and is marked with where it comes from.

Code firstSequence the underlying condition before this code
  • poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)
Use additional codeReport with this code when documented
  • Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
Excludes2from H35Not 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)

Where it sits Source: CMS/NCHS

Under:Chapter 7: Diseases of the Eye and AdnexaH30-H36 Disorders of choroid and retinaH35 Other retinal disordersH35.3 Degeneration of macula and posterior pole

Codes under H35.38 (4)

  • H35.381Toxic maculopathy, right eyeBillable
  • H35.382Toxic maculopathy, left eyeBillable
  • H35.383Toxic maculopathy, bilateralBillable
  • H35.389Toxic maculopathy, unspecified eyeBillable

CompareCheck ClaimView Related Codes

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for H35.38 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 H35.38 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

Code First

Underlying conditions that must be sequenced before this code.

  • poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Coder workflow for H35.38

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

Before you code H35.38

  1. H35.38 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewH35.381, H35.382, H35.383, H35.389

    See the relationships section · Guide: How to choose an ICD-10-CM code →

Choose the right path

  1. Does the documentation support one of the more specific codes beneath H35.38?
    Yes → Select that code and continue the checks below on its own page.
    No → H35.38 cannot be reported as written. Where the codes beneath it include an unspecified code, that code applies when the record goes no further; otherwise query for the missing detail.

    ReviewH35.381, H35.382, H35.383, H35.389

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then the code beneath H35.38.
    No → Continue; do not add an underlying condition the record does not document.

Report the code beneath H35.38 that the documentation supports, not H35.38 itself. Then work the Use Additional Code note, and confirm that code is valid for the date of service on its own page.

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).
The underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Excludes2 — not part of H35.38(1 note)

    Coding workflow: The conditions named in this note are not included in H35.38. 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

  • Code First — sequencing check(1 note)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before H35.38. Do not add an underlying condition the record does not document.

    See the official tabular notes · Guidelines I.A.13

  • Use Additional Code — after identifying H35.38(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with H35.38 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

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

Documentation: The underlying condition the Code First note names is documented alongside this condition.

Coding question: How are the two sequenced?

Path: Review the Code First note.

Reason: The underlying condition is sequenced first and the manifestation follows (Guidelines I.A.13).

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with the code beneath H35.38?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

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 H35.38 with…

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

The codes most likely to be picked instead of H35.38 — 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.

  • 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: H35.38 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: H35.38 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: H35.38 vs E09.311 →

  • E09.359— 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 E09.359; it is not part of this code and both may be reported when both are documented.

    Full comparison: H35.38 vs E09.359 →

  • E10.311— 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 E10.311; it is not part of this code and both may be reported when both are documented.

    Full comparison: H35.38 vs E10.311 →

  • E10.359— 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 E10.359; it is not part of this code and both may be reported when both are documented.

    Full comparison: H35.38 vs E10.359 →

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

Toxic maculopathy is a non-billable ICD-10-CM category code (H35.38). A more specific billable subcode must be selected for claims submission.

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. Sequencing: 1 Code First instruction — the underlying condition is sequenced before this code when present. See the Code First notes
  2. 1 Use Additional Code instruction — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  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

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

Related Codes

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

Contextual Map

Every relationship of H35.38 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.

Run H35.38 with these 8 related codes in Claim Check

Hierarchy

Code First (30)

Use Additional Code (15)

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

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

Can H35.38 be billed directly?

No. H35.38 (Toxic maculopathy) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

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
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. "H35.38 — Toxic maculopathy." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/h35.38-toxic-maculopathy

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Toxic maculopathy

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to H35.38 in its code family, with their registry titles.

View all codes in the H35 family