H36.811
H36.811 — Nonproliferative sickle-cell retinopathy, right eye
Billable / specific codeICD-10-CMright
H36.811 is a billable, specific ICD-10-CM code for nonproliferative sickle-cell retinopathy, right eye. It is valid for submission on a claim.
Risk adjustment
H36.811 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 108 Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major0.146 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.
Medicare coverage
H36.811 is named in 14 Medicare coverage policies — 14 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53008Billing and Coding: Intraocular Bevacizumab
- A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
- A56551Billing and Coding: Visual Fields Testing
Related codes at this level
Codes that share H36.81. If H36.811 is not quite right, the correct code is usually one of these.
Questions about H36.811
- Is H36.811 a billable ICD-10-CM code?
- Yes. H36.811 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does H36.811 sit in the tabular list?
- Diseases of the eye and adnexa (H00-H59), in the block Disorders of choroid and retina (H30-H36).