H30-H36 — Disorders of choroid and retina
ICD-10-CM codes H30-H36 cover disorders of choroid and retina, within diseases of the eye and adnexa. The block holds 538 codes across 7 categories, of which 410 are billable and 128 are header codes that cannot be submitted on a claim. 80 of them (15%) require a 7th character.
The 7th character in H30-H36
A code in this block is not complete without its 7th character, and a missing one is a rejected claim rather than a denied one: the clearinghouse never passes it on. 80 of the 538 codes here take one.
- 0
- with macular edema
- 1
- with retinal neovascularization
- 2
- stable
Risk adjustment in H30-H36
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 300 Exudative Macular Degeneration
- HCC 298 Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage
- HCC 108 Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
What else to watch in H30-H36
- 200 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
- 403 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.