Staphyloma posticum, bilateral

This code describes a posterior staphyloma affecting both eyes. A posterior staphyloma is an outpouching or thinning of the sclera and choroid, typically occurring at the posterior pole of the eye, often associated with high myopia. This thinning can lead to visual disturbances and an increased risk of retinal detachment.

Use this code when documentation explicitly states the presence of a posterior staphyloma in both the right and left eyes. This diagnosis is often made during an ophthalmic examination, particularly in patients with severe myopia or other degenerative eye conditions. The physician's notes should clearly indicate the bilateral nature of the condition.

• Ensure the documentation specifies "bilateral" involvement; otherwise, use the appropriate unilateral code.
• Distinguish from anterior staphyloma, which involves the cornea or limbus.
• Consider co-reporting with codes for underlying conditions like high myopia (e.g., H44.2x) if documented.