An Epiretinal Membrane (ERM)—also known as macular pucker or cellophane maculopathy—is a thin, fibrous layer that forms on the surface of the retina, most often over the macula. It can lead to visual distortion, blurred central vision, and metamorphopsia (objects appearing wavy or bent).
The ICD-10 codes for epiretinal membrane are laterality-specific, meaning you must indicate which eye is affected. Accurate documentation is essential for diagnosis, referral, and appropriate reimbursement. In this article, we break down how to code ERM correctly, document key findings, and manage the condition effectively.
ICD-10 Coding for Epiretinal Membrane
| ICD-10 Code | Description |
|---|---|
| H35.371 | Epiretinal membrane, right eye |
| H35.372 | Epiretinal membrane, left eye |
| H35.373 | Epiretinal membrane, bilateral |
Always include the correct laterality based on imaging or exam. Do not use unspecified codes when the affected eye is clearly documented.
Clinical Presentation
Patients may present with:
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Blurred or hazy central vision
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Wavy or distorted lines (metamorphopsia)
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Difficulty reading or doing detailed work
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Double vision in one eye (monocular diplopia)
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Vision loss in more severe cases
Many mild cases are asymptomatic and discovered during routine eye exams.
Common Causes of Epiretinal Membrane
| Primary Cause | Examples |
|---|---|
| Age-related | Natural degenerative changes in the vitreous |
| Post-surgical | Retinal detachment repair, cataract surgery |
| Inflammatory conditions | Uveitis, retinal vasculitis |
| Trauma or injury | Blunt or penetrating eye trauma |
| Diabetic retinopathy | Especially in advanced stages |
| Idiopathic | Unknown cause, typically in elderly patients |
Diagnostic Workflow
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Dilated Fundus Examination
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Visible glistening, wrinkling, or sheen over the macula
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Optical Coherence Tomography (OCT)
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High-resolution cross-sectional image of retinal layers
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Shows membrane thickness, macular distortion, traction
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Fluorescein Angiography (if needed)
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Helps detect concurrent macular edema
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Visual Acuity and Amsler Grid Testing
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Quantifies visual distortion or central field loss
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SOAP Note Example – Epiretinal Membrane (H35.371)
S: “Patient reports gradual blurry vision in right eye, especially when reading. Straight lines appear slightly wavy.”
O: VA: 20/40 OD, 20/25 OS. OCT shows ERM with mild macular traction in right eye. No CME. Fundus exam reveals glistening sheen on macula OD.
A: Epiretinal membrane, right eye – H35.371
P: Observation recommended. Schedule OCT follow-up in 6 months. Patient educated on symptoms that would prompt earlier return. Consider vitrectomy if vision worsens.
Treatment Options
| Management Strategy | Use When… |
|---|---|
| Observation | Visual acuity ≥ 20/40, mild distortion, stable over time |
| Vitrectomy with membrane peel | Moderate to severe vision loss or daily life interference |
| Anti-VEGF (if macular edema) | Coexisting conditions like diabetic macular edema |
Vitrectomy is effective but reserved for visually significant cases due to surgical risk.
Documentation & Coding Best Practices
| ✅ Do This | ❌ Avoid This |
|---|---|
| Specify which eye (right, left, bilateral) | Using unspecified codes (e.g., H35.379) unnecessarily |
| Include OCT findings in your note | Coding ERM without any imaging confirmation |
| Note impact on function and visual acuity | Over-documenting mild, asymptomatic findings |
| Update diagnosis if surgical intervention occurs | Forgetting to track progression on follow-up |
Differential Diagnoses to Rule Out
| Condition | Differentiation Tips |
|---|---|
| Macular Hole | Central dark spot, full-thickness defect on OCT |
| Age-related macular degeneration (AMD) | Drusen, pigmentary changes, geographic atrophy |
| Cystoid Macular Edema (CME) | Honeycomb cysts on OCT; usually responds to meds |
| Central Serous Retinopathy | Dome-shaped detachment on OCT |
| Diabetic macular edema | Seen in context of diabetes and retinal thickening |
Frequently Asked Questions (FAQs)
Can I use H35.371 if the ERM is very mild?
Yes, if documented and confirmed on OCT, even asymptomatic ERMs can be coded—particularly for follow-up tracking and observation.
Should I use H35.373 if both eyes are affected?
Yes, but only if both eyes have confirmed ERMs. Otherwise, code each eye individually.
Is it okay to use this code for a suspected ERM?
No. Only use if confirmed by fundus exam or imaging (especially OCT). For suspicion, consider documenting as a differential or reason for referral.
How DocScrib Simplifies ERM Documentation
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Conclusion
Epiretinal Membranes (ERM) are common in older adults and may be either benign or vision-threatening, depending on location and severity. Use H35.371–373 to capture laterality-specific diagnoses accurately. Proper documentation—including imaging findings, symptoms, and impact on function—is essential for both clinical care and clean billing.
With DocScrib, you can ensure your ERM diagnoses are precise, comprehensive, and easy to maintain over time—whether you’re observing, treating, or referring.