H43.11: Vitreous hemorrhage, right eye

Risk adjustment

H43.11 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• 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

H43.11 is named in 13 Medicare coverage policies: 13 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
• A56453Billing and Coding: Cataract Extraction
• A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
• A56544Billing and Coding: Cataract Extraction