D49.81 — Neoplasm of unspecified behavior of retina and choroid
D49.81 is a billable, specific ICD-10-CM code for neoplasm of unspecified behavior of retina and choroid. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Dark area on retina
- Retinal freckle
Other codes that can never be billed with D49.81
These codes carry an Excludes1 note pointing at D49.81. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading D49.81 alone.
Risk adjustment
D49.81 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
D49.81 is named in 22 Medicare coverage policies — 22 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
- A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- A56462Billing and Coding: Erythropoiesis Stimulating Agents (ESA)
- A56464Billing and Coding: Flow Cytometry
How D49.81 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to D49.81.
- Freckle›retinal
- Retina, retinal›dark area
Related codes at this level
Codes that share D49.8. If D49.81 is not quite right, the correct code is usually one of these.
Questions about D49.81
- Is D49.81 a billable ICD-10-CM code?
- Yes. D49.81 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does D49.81 sit in the tabular list?
- Neoplasms (C00-D49), in the block Neoplasms of unspecified behavior (D49).