Crystal's MCW Coder HubH43.392
Short Definition
Other vitreous opacities of the left eye, including vitreous floaters — condensations, debris, cells, or other opacities within the vitreous body of the left eye that produce symptomatic visual disturbances such as spots, threads, cobwebs, or shadows in the visual field.
Long Clinical Definition
H43.392 describes other vitreous opacities of the left eye, a category that encompasses the most clinically common vitreous opacity — vitreous floaters — as well as other non-hemorrhagic, non-crystalline opacities within the vitreous body that are not otherwise classified in more specific sub-categories.
The vitreous humor is a transparent, gel-like substance that fills the posterior segment of the eye between the lens and retina. It is composed primarily of water, collagen fibrils, and hyaluronic acid. With aging, myopia, inflammation, trauma, or other pathologic processes, the vitreous undergoes syneresis (liquefaction and shrinkage), leading to condensation of collagen fibrils, formation of opaque deposits, and eventual posterior vitreous detachment (PVD) — separation of the posterior vitreous face from the retina.
These condensations and opaque particles cast shadows on the retina, perceived by the patient as floaters — dots, threads, cobwebs, or ring-shaped shadows (the classic Weiss ring following PVD) that move with eye movement and drift when the eye is still.
Most vitreous floaters are benign and self-limiting, requiring only reassurance and observation. However, acute-onset floaters, particularly when accompanied by photopsia (flashes of light), require urgent evaluation to exclude retinal tear or detachment, which would shift the principal diagnosis to H33.3x or H33.0x-H33.2x respectively.
Anatomic and Clinical Context
Location: Left eye, vitreous body (posterior segment, filling the space between lens/posterior capsule and retina).
Key structures involved:
- Vitreous humor (gel matrix of collagen and hyaluronic acid).
- Posterior vitreous face and vitreoretinal interface.
- Retina (at risk in acute PVD with vitreous traction).
- Macula (at risk if opacity or associated ERM affects central vision).
Common types of vitreous opacities coded to H43.392:
- Floaters (myodesopsias) — condensed collagen fibrils, most common cause.
- Weiss ring — circular opacity at the optic disc corresponding to complete PVD.
- Inflammatory cells — from prior uveitis, intermediate uveitis (pars planitis).
- Pigment cells (tobacco dust / Shafer sign) — pigment granules in vitreous; highly associated with retinal break — urgent finding.
- Red blood cells — minor vitreous hemorrhage presenting primarily as floaters rather than dense hemorrhage (for dense hemorrhage use H43.12x).
- Asteroid hyalosis-related opacities — though asteroid hyalosis itself is H43.2x, residual opacities may occasionally fall under H43.39x.
Risk factors:
- Advancing age (most common).
- High myopia (accelerates vitreous syneresis and PVD).
- Prior ocular surgery (cataract surgery, vitreoretinal surgery).
- Trauma.
- Ocular inflammation (uveitis, intermediate uveitis).
- Systemic disease (diabetes, sickle cell, hypertension).
Clinical features:
- Subjective floaters — described as spots, threads, cobwebs, rings, curtains.
- Photopsias (flashes) — if vitreoretinal traction is present.
- Possible decreased visual acuity if opacity is dense or involves the visual axis.
- Examination findings — vitreous condensations, PVD ring, cells, debris, or pigment granules visible on slit-lamp or dilated fundus exam.
Official Code Structure and Tree
ICD-10-CM Code Tree
- H00-H59 Diseases of the eye and adnexa
- H43-H44 Disorders of vitreous body and globe
- H43 Disorders of vitreous body
- H43.0 Vitreous prolapse
- H43.1 Vitreous hemorrhage
- H43.11 Vitreous hemorrhage, right eye
- H43.12 Vitreous hemorrhage, left eye
- H43.13 Vitreous hemorrhage, bilateral
- H43.2 Crystalline deposits in vitreous body
- H43.21 Crystalline deposits in vitreous body, right eye
- H43.22 Crystalline deposits in vitreous body, left eye
- H43.23 Crystalline deposits in vitreous body, bilateral
- H43.3 Other vitreous opacities (includes vitreous floaters)
- H43.391 Other vitreous opacities, right eye
- H43.392 Other vitreous opacities, left eye
- H43.393 Other vitreous opacities, bilateral
- H43.399 Other vitreous opacities, unspecified eye
- H43.8 Other disorders of vitreous body
- H43.81 Vitreous degeneration
- H43.811 Vitreous degeneration, right eye
- H43.812 Vitreous degeneration, left eye
- H43.813 Vitreous degeneration, bilateral
- H43.82 Vitreomacular adhesion
- H43.89 Other vitreous disorders
- H43.81 Vitreous degeneration
- H43.9 Unspecified disorder of vitreous body
- H43 Disorders of vitreous body
- H43-H44 Disorders of vitreous body and globe
H43.392 is a billable, lateralized, specific ICD-10-CM code.
Includes / Excludes / Code Also
Includes (at H43.3 level)
- Vitreous floaters of the left eye.
- Other non-hemorrhagic, non-crystalline opacities of the vitreous body, left eye.
- Weiss ring floater (PVD-associated opacity) in the left eye.
- Inflammatory cell debris or pigment granules in the vitreous of the left eye, when not separately classified.
Excludes1 (at H43 level — these are separate sub-categories, not coded with H43.392 for the same eye when these apply)
- Vitreous abscess — H44.02x (infectious endophthalmitis with abscess; a far more serious condition)
- Vitreous hemorrhage, left eye — H43.12 (dense blood in vitreous; if primarily hemorrhagic, use H43.12, not H43.392)
- Crystalline deposits in vitreous, left eye — H43.22 (asteroid hyalosis, synchysis scintillans)
- Vitreous degeneration, left eye — H43.812 (PVD/syneresis as the primary pathology; can be coded together with H43.392 when both are present and documented)
Code Also / Use Additional
- Underlying systemic condition when vitreous opacities are a manifestation of a documented systemic disease:
- Diabetic vitreous pathology — E11.3xx or appropriate diabetic eye disease code.
- Sickle cell retinopathy — D57.xx.
- Posterior vitreous detachment — H43.812 (vitreous degeneration, left eye) when PVD is the documented etiology for the floaters.
- Uveitis or iridocyclitis — H20.0x-H20.1x when inflammatory cells in vitreous are secondary to documented uveitis.
- Retinal tear or detachment — H33.3x or H33.0x-H33.2x if discovered on evaluation; these would then become the primary diagnosis.
HCC / Risk Adjustment
- HCC status: H43.392 does not map to a CMS-HCC and does not generate RAF in standard Medicare Advantage risk models.
- Indirect RAF consideration: If vitreous opacities are related to an underlying HCC-mapped condition (e.g., proliferative diabetic retinopathy, sickle cell disease, chronic uveitis from HLA-B27 spondylitis), those underlying conditions should be coded and will carry their respective HCC weight.
- No special documentation steps are needed from an HCC standpoint for H43.392 itself.
MS-DRG Considerations
- H43.392 is an outpatient/office-based diagnosis in virtually all presentations.
- Inpatient admission is rare and would typically occur only when vitreous pathology is part of a complex posterior segment surgical case requiring overnight hospital admission.
- If inpatient admission occurs involving vitreous surgery:
- MDC 02 - Diseases and Disorders of the Eye would apply.
- DRG assignment depends on procedures performed and comorbidities.
- The vitreous opacity itself is unlikely to be the DRG driver — the underlying pathology or procedure is more likely to determine DRG.
- Ambulatory surgery center (ASC) and outpatient hospital settings are the typical locations for all procedures associated with H43.392.
Relationship to CPT, wRVUs, and Assistant at Surgery
wRVUs
ICD-10-CM codes do not carry wRVUs. For H43.392, wRVUs are generated by the CPT service codes used:
Ophthalmological Exam Codes
| CPT | Description |
|---|---|
| 92004 | Ophthalmological services, new patient, comprehensive |
| 92012 | Ophthalmological services, established patient, intermediate |
| 92014 | Ophthalmological services, established patient, comprehensive |
Diagnostic Imaging Codes
| CPT | Description | Notes |
|---|---|---|
| 92250 | Fundus photography with interpretation and report | Bilateral documentation of vitreous/retinal status |
| 92134 | OCT retina scanning | Posterior segment OCT to assess retinal integrity, ERM, macular status |
| 76512 | B-scan ultrasound | When vitreous opacity is dense enough to limit fundus view |
Procedural Codes
| CPT | Description | Coverage Notes |
|---|---|---|
| 67031 | Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery | YAG laser vitreolysis; coverage varies widely — many payers consider experimental for floaters; no Medicare MAC LCD established |
| 67036 | Vitrectomy, mechanical, pars plana approach | More widely covered when significant functional impairment documented |
| 67039 | Vitrectomy with focal endolaser | For concurrent retinal pathology |
| 67040 | Vitrectomy with panretinal photocoagulation endolaser | For concurrent proliferative retinopathy |
| 67041 | Vitrectomy with removal of preretinal cellular membrane | For concurrent epiretinal membrane |
| 67299 | Unlisted procedure, posterior segment | Used when procedure does not map cleanly to existing descriptor |
Reference the current MPFS for wRVU values for each CPT code.
Assistant at Surgery
- 67031 (YAG laser vitreolysis): Single-surgeon minor laser procedure performed at the slit-lamp. Assistant at surgery is not applicable.
- 67036-67041 (Pars plana vitrectomy): Major posterior segment surgery. Check the MPFS assistant-at-surgery indicator for the specific CPT — many vitrectomy codes allow an assistant when medically necessary. Documentation of complexity (dense opacities, prior surgery, membranous disease, retinal involvement) supports assistant billing.
- Always verify the specific CPT code’s MPFS assistant-at-surgery indicator before billing.
Critical Coding Distinctions — H43.392 vs. Related Codes
| Code | Description | Use When |
|---|---|---|
| H43.392 | Other vitreous opacities, left eye | Floaters, Weiss ring, non-hemorrhagic vitreous debris, left eye |
| H43.12 | Vitreous hemorrhage, left eye | Predominantly hemorrhagic vitreous opacity (blood in vitreous); not primarily floaters |
| H43.22 | Crystalline deposits in vitreous, left eye | Asteroid hyalosis, synchysis scintillans |
| H43.812 | Vitreous degeneration, left eye | PVD, vitreous syneresis — may be coded together with H43.392 when both are present |
| H33.391 | Retinal break without detachment, left eye | Retinal tear found on evaluation for floaters; this becomes primary diagnosis |
| H33.002 | Unspecified retinal detachment with retinal break, left eye | Retinal detachment found on evaluation; this becomes primary diagnosis |
| H20.052 | Hypopyon, left eye | Inflammatory cells in anterior chamber; if cells are in vitreous from uveitis, code uveitis as primary |
Coding Examples
Example 1 — Established Patient, Symptomatic Floaters, New PVD, Left Eye
Scenario 58-year-old established patient, highly myopic, presents with 1-week history of new floaters and occasional photopsias in the left eye. Dilated exam reveals posterior vitreous detachment with Weiss ring, left eye. No retinal tear or detachment. Visual acuity stable. Patient reassured, return to clinic in 4-6 weeks.
ICD-10-CM
- H43.392 - Other vitreous opacities, left eye (floaters/Weiss ring).
- H43.812 - Vitreous degeneration, left eye (PVD as documented etiology).
- H52.12 - Myopia, left eye (relevant contributing factor).
CPT
- 92014 - Ophthalmological services, established patient, comprehensive (dilated exam).
- 92250 - Fundus photography with interpretation (documentation of PVD and retinal status).
Example 2 — New Patient, Acute Floaters with Retinal Tear Found, Left Eye
Scenario 42-year-old new patient presents urgently with sudden-onset floaters and photopsias, left eye. Dilated exam reveals vitreous floaters/debris AND a small superior temporal horseshoe retinal tear, left eye. Laser retinopexy performed same day.
ICD-10-CM
- H33.312 - Horseshoe tear of retina without detachment, left eye (primary diagnosis — the tear is the more significant finding and drives treatment).
- H43.392 - Other vitreous opacities, left eye (secondary — the floaters are present but the tear is the priority).
CPT
- 92004 - Ophthalmological services, new patient, comprehensive.
- 67145 - Prophylaxis of retinal detachment, laser (retinopexy for the retinal tear).
- Modifier 25 on 92004 if billing E/M and procedure same day and payer requires separate identification.
Example 3 — YAG Laser Vitreolysis for Symptomatic Left Eye Floaters
Scenario 67-year-old with visually significant left eye floaters documented over 12+ months, significantly impacting reading and driving. Conservative observation has failed. YAG laser vitreolysis performed.
ICD-10-CM
- H43.392 - Other vitreous opacities, left eye.
- H43.812 - Vitreous degeneration, left eye (PVD documented as etiology).
CPT
- 67031 - Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery.
Coverage note: Prior authorization should be obtained where required. Many payers, including some Medicare MACs, do not have published LCDs supporting routine coverage of YAG laser vitreolysis for floaters and may consider it investigational. Documentation of functional visual impairment and failure of conservative management is essential.
Example 4 — Pars Plana Vitrectomy for Dense Vitreous Opacities, Left Eye
Scenario 72-year-old with history of prior uveitis presenting with visually significant, persistent vitreous opacities left eye with documented 20/100 visual acuity, inability to read, and confirmed failure of conservative management. Pars plana vitrectomy performed in ASC.
ICD-10-CM
- H43.392 - Other vitreous opacities, left eye (primary indication for surgery).
- H20.12 - Chronic iridocyclitis, left eye (underlying cause of vitreous opacities).
CPT
- 67036 - Vitrectomy, mechanical, pars plana approach.
- Check MPFS assistant-at-surgery indicator if assistant is present.
Key Coding Pearls
- H43.392 is for floaters and other non-hemorrhagic, non-crystalline vitreous opacities left eye. It is not a catch-all vitreous code — hemorrhage (H43.12), crystalline deposits (H43.22), and degeneration (H43.812) each have their own sub-categories.
- Code PVD alongside H43.392 (H43.812 for same eye) when PVD is documented as the etiology of the floaters — they are not mutually exclusive.
- Acute floaters with photopsias are urgent. If a retinal tear or detachment is found, those codes (H33.3x, H33.0x) supersede H43.392 as the primary diagnosis.
- Tobacco dust (pigment in vitreous) is a red flag finding — strongly associated with retinal break. If documented in the workup note, evaluate carefully for H33.3x before settling on H43.392.
- Laterality is required — never default to H43.399 (unspecified) when the affected eye is clearly documented.
Suggested Obsidian Linkouts
- H20.051 - Hypopyon, right eye
- Uveitis and Iridocyclitis - Clinical Overview
- Ophthalmology CPT Codes Reference
- Global Surgical Package MOC
- -22 - Modifier 22 for complex vitrectomy cases
- -25 - Modifier 25 for same-day E/M and procedure