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H44.132

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H44.132 — Retinal detachment with single break, left eye

Short definition

H44.132 identifies rhegmatogenous retinal detachment (RRD) of the left eye caused by a single retinal break — a full-thickness retinal tear or dialysis through which liquefied vitreous fluid passes, elevating the retina from the underlying retinal pigment epithelium.

Long clinical definition

Rhegmatogenous retinal detachment (RRD) occurs when liquefied vitreous passes through a full-thickness retinal break, creating a subretinal fluid pocket that elevates the neurosensory retina from the retinal pigment epithelium (RPE). H44.132 specifies:

  • Left eye (OS) only.
  • Single break — one discrete retinal tear, hole, dialysis, or giant tear causing the detachment.
  • Rhegmatogenous mechanism — traction-induced retinal break with vitreous fluid as the elevating force (vs. tractional RD from proliferative disease or exudative RD from RPE pump failure).

Clinical hallmarks of H44.132:

  • Symptoms: Photopsia (flashes) from vitreous traction, floaters from vitreous syneresis, and a progressive shadow/curtain in the peripheral visual field sweeping from above/below or nasally toward the center.
  • Exam findings: Elevated retina with visible retinal break(s), often horseshoe tear at lattice degeneration sites, or dialysis at ora serrata.
  • OCT confirmation: Subretinal fluid with shaggy retinal surface and visible break.
  • B-scan ultrasound: If media opaque, confirms retinal elevation and mobility.

Single break distinguishes this from H44.133 (multiple breaks), which has different surgical considerations and prognosis. Single-break RRDs are typically more amenable to scleral buckling alone or PPV with laser.

Code tree context — H44.1 Retinal detachment with retinal break

H44 Disorders of globe

  • H44.0 Endophthalmitis
  • H44.1 Retinal detachment with retinal break (non-billable header)
    • H44.11 Retinal detachment with retinal break, right eye
      • H44.111 — with single break, right eye
      • H44.112 — with multiple breaks, right eye
      • H44.113 — with tears of associated choroid, right eye
      • H44.119 — unspecified, right eye
    • H44.12 Retinal detachment with retinal break, left eye
      • H44.121 — with single break, left eye
      • H44.122 — with multiple breaks, left eye
      • H44.123 — with tears of associated choroid, left eye
      • H44.129 — unspecified, left eye
    • H44.13 Retinal detachment with retinal break, bilateral
      • H44.131 — with single break, bilateral
      • H44.132 — with multiple breaks, bilateral
      • H44.133 — with tears of associated choroid, bilateral
      • H44.139 — unspecified, bilateral
    • H44.20 Partial thickness retinal schisis

Key rule
H44.1x (3-character) is non-billable; always choose a laterality + break-type specific child code such as H44.132.

Includes and excludes

Includes (when left eye, single break)

H44.132 captures:

  • Rhegmatogenous RD OS caused by one retinal tear/hole/dialysis/giant tear.
  • Horseshoe tear RD OS.
  • U-tear or dialysis RD OS.
  • Single break RRD OS with or without proliferative vitreoretinopathy (PVR) grade A/B (low-grade PVR).

Excludes

Excludes1 (never coded together for same eye):

  • Proliferative vitreoretinopathy with retinal detachment — H33.4x
    • When advanced PVR (grade C/D) with fixed folds, membranes, or severe proliferation is present, code H33.4x instead of H44.1x.

Excludes2 (may co-exist but coded separately):

  • Vitreous hemorrhage — H43.1x (if acute bleed obscures view).
  • Retinal tear without detachment — H33.0x (prophylaxis scenario).

Distinguish from similar conditions:

  • Tractional RD (e.g., diabetic) — H33.2x (no retinal break).
  • Exudative/serous RD — H35.7x (no retinal break, RPE dysfunction).
  • Retinoschisis — H44.20x (splitting within retinal layers, not full-thickness detachment).

Typical clinical context

Symptoms (left eye)

  • Acute photopsia OS (flashes from vitreous traction on retina).
  • New floaters OS (vitreous syneresis).
  • Progressive peripheral visual field loss OS — “curtain” or “shadow” sweeping from superior/temporal periphery toward macula.

Exam findings

  • Elevated retina OS with visible single retinal break (horseshoe tear, U-tear, dialysis).
  • Subretinal fluid OS, often bullous if chronic.
  • Relative afferent pupillary defect (RAPD) OS if macula detached.
  • Lattice degeneration or pavingstone degeneration OS as predisposing factor.

Risk factors

  • High myopia OS.
  • Prior cataract surgery OS.
  • Trauma OS.
  • Lattice degeneration OS.
  • Family history of RD.

Relationship to CPT, wRVU, and procedures

H44.132 is a high-acuity diagnosis driving urgent/emergent vitreoretinal surgery:

  • Primary surgical codes

    • 67108 — Repair of retinal detachment with vitrectomy, any method (most common; PPV ± tamponade).
    • 67107 — Repair of retinal detachment; scleral buckling.
    • 67101 — Repair of retinal detachment; cryotherapy (less common).
    • 67110 — Repair by pneumatic retinopexy (PRP for superior single-break RRDs).

  • Diagnostic codes

    • 92134 — OCT retina OS (pre/post-op evaluation).
    • 92201 — Extended ophthalmoscopy with retinal drawing OS.
    • 76519 — B-scan ultrasound OS (if media opaque).

  • E/M and exams

    • 92004 / 92014 — Comprehensive ophthalmologic exam.
    • 9920x — Urgent/emergent E/M for acute RD presentation.

wRVUs (approximate 2026)

  • 67108 ~18.5 wRVU (PPV for RD).
  • 67107 ~15.2 wRVU (scleral buckle).
  • 92134 ~0.4 wRVU (OCT).

H44.132 supports medical necessity for emergent surgical intervention.

HCC / risk adjustment

  • H44.132 does not map to a CMS-HCC.
  • It is not a CC or MCC in MS-DRG logic.
  • Risk impact comes from systemic comorbidities:
    • E11.3x1 — Diabetic retinopathy (if tractional component).
    • Z79.899 — Long-term anticoagulant use (increased hemorrhage risk).

MS-DRG considerations

H44.132 is high-impact for inpatient vitreoretinal surgery under MDC 02 (eye):

DRGDescriptionWhen
117Intraocular Procedures with MCCRD repair + MCC (e.g., sepsis, respiratory failure)
118Intraocular Procedures with CCRD repair + CC (e.g., pneumonia, dehydration)
119Intraocular Procedures without CC/MCCRD repair, no CC/MCC

RD surgery (67108) is typically inpatient or outpatient depending on complexity, but H44.132 paired with surgery drives surgical eye DRGs.

Coding guidelines and laterality

Laterality and break specificity

  • Left eye, single break → H44.132.
  • Right eye, single break → H44.111.
  • Left eye, multiple breaks → H44.122.
  • Bilateral, single break → H44.131.

Break type clarification

  • “Single break” = one discrete tear/hole/dialysis/giant tear.
  • “Multiple breaks” = 2+ breaks.
  • “Tears of associated choroid” = choroidal detachment with RD (H44.123).

Do not use H44.1x (3-character) — always select the specific laterality + break-type child code.

When not to use H44.132

  • No retinal break present → tractional RD (H33.2x) or exudative RD (H35.7x).
  • Advanced PVR → H33.4x (proliferative vitreoretinopathy with RD).
  • Prophylaxis → retinal tear without detachment (H33.0x).

Common coding scenarios

Example 1 — Acute single-break RRD OS, pneumatic retinopexy

Scenario
55-year-old myopic patient presents with 24 hours of superior nasal field loss OS. Exam: superior temporal horseshoe tear OS with bullous detachment extending to macula.

ICD-10-CM

  • H44.132 — Retinal detachment with single break, left eye.

CPT

  • 67110 — Repair of retinal detachment; by injection of air or other gas (pneumatic retinopexy).
  • 67141 — Prophylaxis of retinal detachment without drainage; cryotherapy (laser or cryo to tear).

Example 2 — Single-break RRD OS with PPV repair

Scenario
72-year-old post-cataract surgery OS, presents with inferior curtain OS. Exam: single dialysis OS with inferior detachment.

ICD-10-CM

  • H44.132 — Retinal detachment with single break, left eye.
  • Z98.890 — Other specified postprocedural states (history of cataract surgery).

CPT

  • 67108 — Repair of retinal detachment; with vitrectomy, any method, including drainage of subretinal fluid, scleral buckling, etc.

Example 3 — Single-break RRD OS with scleral buckle

Scenario
38-year-old with lattice degeneration OS, presents with temporal curtain OS. Exam: horseshoe tear at lattice site OS with macula-on detachment.

ICD-10-CM

  • H44.132 — Retinal detachment with single break, left eye.
  • H35.449 — Peripheral lattice degeneration OS.

CPT

  • 67107 — Repair of retinal detachment; scleral buckling operation.
  • 67145 — Prophylaxis of retinal detachment; photocoagulation.

Example 4 — Bilateral single-break RD (uncommon)

Scenario
45-year-old with bilateral high myopia presents with bilateral field loss. Exam: single tear OD and single tear OS, both macula-on.

ICD-10-CM

  • H44.131 — Retinal detachment with single break, bilateral.

CPT

  • 67108-50 — PPV for RD, bilateral (modifier -50).

Coding note
Bilateral RD is rare; document bilateral symptoms and findings explicitly.

Example 5 — Single-break RRD with vitreous hemorrhage

Scenario
62-year-old with acute vision loss OS. Exam: vitreous hemorrhage OS obscuring view; B-scan shows single-break RD OS.

ICD-10-CM

  • H44.132 — Retinal detachment with single break, left eye (primary, confirmed by ultrasound).
  • H43.12 — Vitreous hemorrhage, left eye (secondary).

CPT

  • 67108 — PPV with RD repair and vitreous hemorrhage evacuation OS.

Documentation pearls

  • Specify number of breaks (single vs. multiple) and laterality.
  • Document extent of detachment (macula-on vs. macula-off, quadrants involved).
  • Note break type (horseshoe tear, U-tear, dialysis, giant tear) and location (superior, temporal, nasal).
  • Include predisposing factors (lattice, myopia, trauma, post-cataract).
  • For prophylaxis or repair, document peripheral exam findings and laser/cryo treatment.

Precise documentation supports code specificity (H44.132 vs. H44.122) and medical necessity for urgent surgery.

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