Is H21.4 a billable ICD-10-CM code?

No. H21.4 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does H21.4 sit in the tabular list?

Diseases of the eye and adnexa (H00-H59), in the block Disorders of sclera, cornea, iris and ciliary body (H15-H22).

What cannot be coded together with H21.4?

H21.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

H21.4

H21.4 — Pupillary membranes

Non-billable headerICD-10-CM

H21.4 is a non-billable header ICD-10-CM code for pupillary membranes. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

congenital pupillary membranes (Q13.8)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Iris bombé
Pupillary occlusion
Pupillary seclusion

Risk adjustment

H21.4 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.

Code to one of these instead H21.4

4 child codes. Green means billable.

Related codes at this level

Codes that share H21. If H21.4 is not quite right, the correct code is usually one of these.

Questions about H21.4

Is H21.4 a billable ICD-10-CM code?: No. H21.4 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does H21.4 sit in the tabular list?: Diseases of the eye and adnexa (H00-H59), in the block Disorders of sclera, cornea, iris and ciliary body (H15-H22).
What cannot be coded together with H21.4?: H21.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.