Is H31.011 a billable ICD-10-CM code?

Yes. H31.011 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does H31.011 sit in the tabular list?

Diseases of the eye and adnexa (H00-H59), in the block Disorders of choroid and retina (H30-H36).

What cannot be coded together with H31.011?

H31.011 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H31.011 (H31.01) and apply to it just the same.

H31.011

H31.011 — Macula scars of posterior pole (postinflammatory) (post-traumatic), right eye

Billable / specific codeICD-10-CMright

H31.011 is a billable, specific ICD-10-CM code for macula scars of posterior pole (postinflammatory) (post-traumatic), right eye. It is valid for submission on a claim.

Excludes1 inherited from the categories above H31.011

These are not written on H31.011, but they bind it: a note on a category applies to every code beneath it. Billing H31.011 with anything listed here is a denial.

Written on H31.01 — Macula scars of posterior pole (postinflammatory) (post-traumatic)

postprocedural choriorentinal scar (H59.81-)

Excludes2 inherited from the categories above H31.011

Also inherited, and the opposite of Excludes1: these conditions are not part of H31.011, but a patient can have both, so you may code both.

Written on H31.0 — Chorioretinal scars

postsurgical chorioretinal scars (H59.81-)

Risk adjustment

H31.011 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

H31.011 is named in 12 Medicare coverage policies — 12 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
A56672Billing and Coding: Electroretinography (ERG)
A56726Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

Code history

H31.011 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share H31.01. If H31.011 is not quite right, the correct code is usually one of these.

Questions about H31.011

Is H31.011 a billable ICD-10-CM code?: Yes. H31.011 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does H31.011 sit in the tabular list?: Diseases of the eye and adnexa (H00-H59), in the block Disorders of choroid and retina (H30-H36).
What cannot be coded together with H31.011?: H31.011 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H31.011 (H31.01) and apply to it just the same.