Is Q11.3 a billable ICD-10-CM code?

Yes. Q11.3 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Q11.3 sit in the tabular list?

Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0), in the block Congenital malformations of eye, ear, face and neck (Q10-Q18).

What cannot be coded together with Q11.3?

Q11.3 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

Q11.3

Q11.3 — Macrophthalmos

Billable / specific codeICD-10-CMPOA exempt

Q11.3 is a billable, specific ICD-10-CM code for macrophthalmos. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

macrophthalmos in congenital glaucoma (Q15.0)

Risk adjustment

Q11.3 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

Q11.3 is named in 2 Medicare coverage policies — 2 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
A57204Billing and Coding: MRI and CT Scans of the Head and Neck

How Q11.3 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to Q11.3.

Macrophthalmos
Megalophthalmos

Related codes at this level

Codes that share Q11. If Q11.3 is not quite right, the correct code is usually one of these.

Questions about Q11.3

Is Q11.3 a billable ICD-10-CM code?: Yes. Q11.3 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Q11.3 sit in the tabular list?: Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0), in the block Congenital malformations of eye, ear, face and neck (Q10-Q18).
What cannot be coded together with Q11.3?: Q11.3 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.