H36.823: Proliferative sickle-cell retinopathy, bilateral

Risk adjustment

H36.823 risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:

• HCC 108 Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major0.146 RAF
• HCC 298 Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage0.336 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

H36.823 is named in 14 Medicare coverage policies: 14 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• 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