Retinopathy of prematurity, stage 3, bilateral

This code signifies a severe form of retinopathy of prematurity (ROP) affecting both eyes, characterized by abnormal blood vessel growth extending into the vitreous humor. Stage 3 ROP involves extraretinal fibrovascular proliferation, which can lead to retinal detachment if left untreated. This condition is typically observed in premature infants.

This code is appropriate when documentation confirms a diagnosis of Stage 3 ROP in both the right and left eyes. It should be used for premature infants exhibiting the characteristic ridge with neovascularization extending into the vitreous. Supporting documentation includes ophthalmological examination reports detailing the stage and bilateral involvement.

• Ensure the medical record explicitly states "Stage 3" and "bilateral" involvement for accurate coding.
• Differentiate from other stages of ROP (H35.12-H35.15) and unilateral involvement (H35.141, H35.142).
• Consider sequencing this code after a code for prematurity or low birth weight, if applicable, to establish medical necessity.