Is H36.89 a billable ICD-10-CM code?

Yes. H36.89 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does H36.89 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 H36.89?

H36.89 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 H36.89 (H36) and apply to it just the same.

H36.89

H36.89 — Other retinal disorders in diseases classified elsewhere

Billable / specific codeICD-10-CM

H36.89 is a billable, specific ICD-10-CM code for other retinal disorders in diseases classified elsewhere. It is valid for submission on a claim.

Inclusion terms

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

Retinal dystrophy in lipid storage disorders

Excludes1 inherited from the categories above H36.89

These are not written on H36.89, but they bind it: a note on a category applies to every code beneath it. Billing H36.89 with anything listed here is a denial.

Written on H36 — Retinal disorders in diseases classified elsewhere

arteriosclerotic retinopathy (H35.0-)
diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)

Risk adjustment

H36.89 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

H36.89 is named in 15 Medicare coverage policies — 15 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
A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
A56551Billing and Coding: Visual Fields Testing
A56672Billing and Coding: Electroretinography (ERG)

Code history

H36.89 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 H36.8. If H36.89 is not quite right, the correct code is usually one of these.

Questions about H36.89

Is H36.89 a billable ICD-10-CM code?: Yes. H36.89 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does H36.89 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 H36.89?: H36.89 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 H36.89 (H36) and apply to it just the same.