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H43.822

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H43.822

Short Definition

Vitreomacular adhesion of the left eye — a condition of the vitreoretinal interface in which the posterior vitreous cortex remains abnormally attached to the macula during an incomplete posterior vitreous detachment, ranging from asymptomatic adhesion without retinal distortion (VMA) to symptomatic traction with documented macular morphologic change (VMT).

Long Clinical Definition

H43.822 captures vitreomacular adhesion (VMA) and its symptomatic form, vitreomacular traction (VMT), in the left eye. These conditions exist along a spectrum of vitreoretinal interface pathology arising from incomplete posterior vitreous detachment (PVD).

Under normal conditions, the vitreous cortex adheres to the entire posterior retinal surface. As age-related vitreous syneresis and PVD progress, the posterior vitreous face separates cleanly from the retina in most patients. However, in some individuals, pathologically strong adhesions persist at the macula while the surrounding vitreous has already separated — the partially detached posterior vitreous then exerts anteroposterior traction on the fovea and surrounding macular tissue.

When this traction is mild and the foveal architecture remains normal on OCT, the condition is classified as VMA — vitreomacular adhesion. When traction is sufficient to produce visible macular distortion, pseudocyst formation, intraretinal fluid, or incipient macular hole on OCT, it is classified as VMT — vitreomacular traction syndrome. Both states are captured under H43.822 in ICD-10-CM.

The clinical significance is considerable: VMT can progress to full-thickness macular hole, cause persistent metamorphopsia and reduced central visual acuity, and exacerbate concurrent macular conditions such as diabetic macular edema and exudative AMD.

Anatomic and Clinical Context

Location: Left eye, vitreoretinal interface at the macula (fovea and perifoveal region).

Adhesion zone diameter classification (IVTS — International Vitreomacular Traction Study Group):

ClassificationAdhesion DiameterAssociation
Focal VMA/VMTLess than or equal to 1500 micrometersVitreofoveolar traction, microhole, lamellar hole, full-thickness macular hole
Broad VMA/VMTGreater than 1500 micrometersVMT syndrome, tractional DME exacerbation, exudative AMD exacerbation

Vitreoretinal adhesion sites (strongest):

  • Vitreous base (anterior — rarely involved in VMA/VMT).
  • Fovea and perifoveal zone — VMA/VMT occurs here.
  • Optic disc margin (vitreopapillary adhesion).
  • Retinal vessels.

Common symptoms:

  • Decreased central visual acuity.
  • Metamorphopsia — distorted, wavy, or warped central vision.
  • Micropsia — objects appear smaller than actual size.
  • Central scotoma (partial or complete) in advanced VMT.
  • Reading difficulty.

OCT hallmarks:

FindingDescription
Elevated posterior hyaloidVitreous cortex elevated above retinal surface in perifoveal area but attached at fovea
Persistent foveal attachmentVitreous-retinal junction visible at fovea; acute angle between hyaloid and retinal surface
Foveal distortion (VMT)Inward pulling/distortion of inner foveal contour
Intraretinal pseudocystIntraretinal fluid/cyst at fovea from traction
Lamellar or full-thickness macular holeProgressive complication of unresolved VMT

Natural history:

  • Spontaneous resolution of VMA/VMT occurs in approximately 30% of cases within 1-2 years of observation.
  • Resolution is more common with focal VMT (less than or equal to 1500 micrometers) than broad VMT.
  • Risk factors for progression to macular hole: small adhesion diameter, high tractional forces, presence of epiretinal membrane.

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
        • H43.2 Crystalline deposits in vitreous body
        • H43.3 Other vitreous opacities (floaters)
        • 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
            • H43.821 Vitreomacular adhesion, right eye
            • H43.822 Vitreomacular adhesion, left eye
            • H43.823 Vitreomacular adhesion, bilateral
            • H43.829 Vitreomacular adhesion, unspecified eye
          • H43.89 Other disorders of vitreous body
        • H43.9 Unspecified disorder of vitreous body

H43.822 is a billable, lateralized, specific ICD-10-CM code valid for FY2026.

Includes / Excludes / Code Also

Includes (at H43.82 level)

  • Vitreomacular adhesion (VMA), left eye — persistent macular attachment without morphologic retinal distortion.
  • Vitreomacular traction (VMT), left eye — persistent macular attachment with documented foveal/macular distortion on OCT.
  • Vitreofoveal adhesion or traction, left eye.
  • Incomplete posterior vitreous detachment with macular attachment, left eye.
  • Vitreopapillary adhesion/traction component when coincident with VMA (code together with H43.812 if both optic disc and macular attachment are documented).

Excludes1 (at H43.8 level — cannot be coded with H43.822)

  • Proliferative vitreoretinopathy with retinal detachment — H33.4x (Excludes1 — these conditions cannot coexist as coded; if PVR with RD develops from traction, H33.4x takes precedence).

Excludes2 (at H43 level — separate conditions, can co-exist)

  • Vitreous abscess — H44.02x (infectious; unrelated process; can be coded separately if both are present).

Code Also / Use Additional Code

The following are commonly coded alongside H43.822 when documented:

  • Vitreous degeneration, left eye — H43.812 (incomplete PVD — the underlying mechanism of VMA/VMT; code together).
  • Other vitreous opacities (floaters), left eye — H43.392 (if symptomatic floaters are also present).
  • Epiretinal membrane, left eye — H35.372 (ERM frequently coexists with VMA/VMT and should be coded separately).
  • Lamellar macular hole, left eye — H35.342 (if present).
  • Full-thickness macular hole, left eye — H35.322 (if VMT has progressed to macular hole; this becomes the primary diagnosis).
  • Diabetic macular edema, left eye — E11.311 or appropriate E code with .31x suffix (if VMT is exacerbating DME in a diabetic patient).
  • High myopia, left eye — H52.12 (if myopia is a contributing factor).

HCC / Risk Adjustment

  • HCC status: H43.822 does not map to a CMS-HCC.
  • Indirect considerations:
    • When VMA/VMT coexists with macular hole (H35.322) or with DME in a diabetic patient (E11.311), those conditions may contribute to quality metrics, RAF, or care complexity coding.
    • Full clinical documentation of all concurrent macular and retinal pathologies is essential for CDI completeness.

MS-DRG Considerations

  • H43.822 is effectively an outpatient and ASC-only diagnosis in standard practice.
  • Inpatient admission for VMA/VMT alone would be atypical.
  • If surgical treatment requires hospital admission:
    • MDC 02 - Diseases and Disorders of the Eye applies.
    • DRG driven by the procedure performed (PPV, membrane peel, ILM peel) and comorbidities.
    • H43.822 would typically be a secondary contributor rather than the primary DRG driver.
  • ASC or outpatient hospital is the standard care setting for all procedures associated with H43.822.

Relationship to CPT, wRVUs, and Assistant at Surgery

wRVUs

ICD-10-CM codes carry no wRVUs. For H43.822, wRVUs are generated by CPT service codes:

Ophthalmological Exam Codes

CPTDescription
92004New patient, comprehensive ophthalmological exam
92012Established patient, intermediate ophthalmological exam
92014Established patient, comprehensive ophthalmological exam

Diagnostic Imaging

CPTDescriptionNotes
92134OCT retinaPrimary and essential imaging for VMA/VMT diagnosis and monitoring
92250Fundus photographyDocumentation of vitreoretinal anatomy and concurrent pathology
76512B-scan ultrasoundWhen media opacity limits fundus view

Procedural Codes

CPTDescriptionNotes
67028Intravitreal injection of pharmacologic agentHistorically used for ocriplasmin (J7316); ocriplasmin discontinued in US as of 2020; may apply to future pharmacologic enzymatic vitreolysis agents
67036Vitrectomy, mechanical, pars plana approachBase PPV for VMT release when surgery is indicated
67041PPV with preretinal cellular membrane removalWhen ERM coexists with VMT
67042PPV with internal limiting membrane removalFor macular hole repair or VMT with ILM peel strategy
67039PPV with focal endolaser photocoagulationFor concurrent retinal pathology requiring focal laser

Reference the current year MPFS for specific wRVU values per CPT code.

Assistant at Surgery

  • 67028 (intravitreal injection): Single-surgeon minor office procedure. Assistant not applicable.
  • 67036 (base PPV): Check MPFS assistant indicator for the specific code — varies by complexity documentation.
  • 67041 (PPV with membrane peel): More complex; check MPFS indicator. When complexity is documented, modifier 80 or 82 may apply.
  • 67042 (PPV with ILM peel): Complex posterior segment surgery. MPFS indicator should be verified — many ILM peel cases allow an assistant when documented.
  • Always verify the exact CPT code’s MPFS assistant-at-surgery indicator before billing.

Pharmacologic Treatment Note (Historical)

Ocriplasmin (Jetrea, J7316)

  • FDA-approved October 2012 for treatment of symptomatic VMA, including when associated with a macular hole of less than or equal to 400 micrometers.
  • Mechanism — truncated recombinant form of human plasmin that enzymatically cleaves fibronectin and laminin at the vitreoretinal interface, inducing pharmacologic vitreolysis.
  • Trial data — MIVI-TRUST Phase III trials showed 26.5% VMA resolution vs. 10.1% placebo at 28 days; secondary outcome showed reduction in vitrectomy rate (17.7% vs. 26.6%).
  • Ocriplasmin manufacturing and distribution in the United States was discontinued in 2020 — it is no longer commercially available in the US as of the current date.
  • Coding note: CPT 67028 (intravitreal injection) + J7316 (ocriplasmin 0.125 mg) were the billing codes while it was available. If a future pharmacologic vitreolysis agent is approved and commercially launched, 67028 would again pair with the appropriate HCPCS drug code.

Critical Coding Distinctions

CodeDescriptionUse When
H43.822Vitreomacular adhesion, left eyeVMA or VMT present on OCT without macular hole
H43.812Vitreous degeneration, left eyePVD/syneresis — also code with H43.822 when incomplete PVD is the mechanism
H43.392Other vitreous opacities, left eyeFloaters — code alongside if also symptomatic
H35.322Full-thickness macular hole, left eyeVMT has progressed to macular hole — primary diagnosis; H43.822 secondary
H35.342Partial-thickness macular hole, left eyeLamellar or partial-thickness hole from VMT
H35.372Epiretinal membrane, left eyeERM coexisting with VMT — code separately
H33.4xProliferative vitreoretinopathy with RDExcludes1 — cannot be coded with H43.822

Coding Examples

Example 1 — Asymptomatic VMA Found Incidentally on OCT, Left Eye

Scenario 68-year-old established patient presents for diabetic eye exam. OCT reveals vitreomacular adhesion, left eye, without foveal distortion. No symptoms of metamorphopsia. Visual acuity 20/25 OU. Observation plan documented with scheduled 6-month follow-up.

ICD-10-CM

  • H43.822 - Vitreomacular adhesion, left eye.
  • H43.812 - Vitreous degeneration, left eye (incomplete PVD as underlying mechanism).
  • E11.3291 - Type 2 diabetes with mild nonproliferative diabetic retinopathy without macular edema, left eye (concurrent diabetic eye disease).

CPT

  • 92014 - Ophthalmological services, established patient, comprehensive.
  • 92134 - OCT retina.
  • 92250 - Fundus photography.

Example 2 — Symptomatic VMT with Metamorphopsia, Left Eye, Conservative Management

Scenario 72-year-old new patient with 3-month history of progressive metamorphopsia and decreased visual acuity to 20/50 left eye. OCT shows focal VMT (800 micrometer adhesion) with foveal pseudocyst and distortion. ERM also present. Patient counseled on options — observation elected initially.

ICD-10-CM

  • H43.822 - Vitreomacular adhesion, left eye (VMT).
  • H43.812 - Vitreous degeneration, left eye (incomplete PVD).
  • H35.372 - Epiretinal membrane, left eye (concurrent ERM).

CPT

  • 92004 - Ophthalmological services, new patient, comprehensive.
  • 92134 - OCT retina.
  • 92250 - Fundus photography.

Example 3 — VMT Progressed to Macular Hole, Surgery Indicated, Left Eye

Scenario 74-year-old returns with worsened vision to 20/200 left eye. OCT shows VMT has progressed to a 350 micrometer full-thickness macular hole. Pars plana vitrectomy with ILM peel scheduled.

ICD-10-CM

  • H35.322 - Full-thickness macular hole, left eye (primary diagnosis — drives surgical decision).
  • H43.822 - Vitreomacular adhesion, left eye (VMT as documented etiology of macular hole).
  • H43.812 - Vitreous degeneration, left eye (incomplete PVD).

CPT (pre-op/surgical planning visit)

  • 92014 - Ophthalmological services, established patient, comprehensive.
  • 92134 - OCT retina.

CPT (surgical case — ASC)

  • 67042 - Vitrectomy with removal of internal limiting membrane (macular hole repair).
  • Check MPFS assistant-at-surgery indicator for 67042 if an assistant is present.

Example 4 — PPV for VMT with ERM Peel, No Macular Hole, Left Eye

Scenario 70-year-old with symptomatic VMT and coexisting ERM, visual acuity 20/80, metamorphopsia significantly impairing function. Conservative management has failed. PPV with combined ERM and ILM peel performed.

ICD-10-CM

  • H43.822 - Vitreomacular adhesion, left eye (VMT — primary surgical indication).
  • H35.372 - Epiretinal membrane, left eye (concurrent, also addressed surgically).
  • H43.812 - Vitreous degeneration, left eye (incomplete PVD).

CPT (surgical case)

  • 67041 - Vitrectomy with removal of preretinal cellular membrane (ERM peel).
  • If ILM was also separately peeled and documented, discuss with surgeon whether 67042 or 67041 more accurately reflects the primary membrane removed per CPT bundling guidance.
  • Modifier 22 on 67041 may be appropriate if combined ERM + ILM peel represents substantially increased surgical work — document intra-operative complexity in detail.

Key Coding Pearls

  • VMA and VMT both map to H43.822 — ICD-10-CM does not subdivide them further. Clinical documentation (OCT findings, symptoms, IVTS classification) differentiates them for clinical purposes; coding uses the same code for both.
  • Always code incomplete PVD concurrently — H43.812 (vitreous degeneration, left eye) is the underlying mechanism and should be coded alongside H43.822 when incomplete PVD is documented.
  • When VMT progresses to macular hole, shift the primary diagnosis — H35.322 (full-thickness macular hole, left eye) becomes primary; H43.822 is retained as secondary context.
  • ERM coexisting with VMT — code H35.372 (ERM, left eye) separately; they are distinct findings with distinct CPT treatment implications.
  • Ocriplasmin is no longer available in the US — do not code J7316 in current practice. If a pharmacologic agent is prescribed, use the appropriate current HCPCS drug code.
  • Laterality is required — never default to H43.829 (unspecified) when the affected eye is clearly documented.
  • Bilateral VMA should be coded as H43.823 when both eyes are affected simultaneously, or H43.821 + H43.822 when documentation describes them separately.

typical_cpt_pairings: office_exam: - code: “92004” description: “Ophthalmological services, new patient, comprehensive” - code: “92012” description: “Ophthalmological services, established patient, intermediate” - code: “92014” description: “Ophthalmological services, established patient, comprehensive” diagnostic_imaging: - code: “92134” description: “Scanning computerized ophthalmic diagnostic imaging, posterior segment, retina (OCT retina) — primary diagnostic tool for VMA/VMT” - code: “92250” description: “Fundus photography with interpretation and report” - code: “76512” description: “B-scan ophthalmic ultrasound — when media opacity limits view” procedures_if_applicable: - code: “67028” description: “Intravitreal injection of pharmacologic agent — historically used for ocriplasmin (no longer commercially available in the US); may apply to future pharmacologic agents” - code: “67036” description: “Vitrectomy, mechanical, pars plana approach — base PPV for VMT release” - code: “67041” description: “Vitrectomy with removal of preretinal cellular membrane (ERM/macular pucker) — when ERM coexists with VMT” - code: “67042” description: “Vitrectomy with removal of internal limiting membrane — when ILM peel performed for macular hole repair or VMT treatment” - code: “67039” description: “Vitrectomy with focal endolaser photocoagulation — when concurrent retinal pathology requires laser” documentation_tips:

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