Question 1

What is ICD-10 code A36.86?

Accepted Answer

A36.86 is the ICD-10-CM diagnosis code for Diphtheritic conjunctivitis. This is an eye infection (conjunctivitis) caused by diphtheria bacteria, which affects the clear membrane covering the white part of the eye and inner eyelids. It is a serious bacterial infection that requires prompt medical treatment. A36.86 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. A36.86 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Question 2

Is A36.86 an HCC code?

Accepted Answer

No. A36.86 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is A36.86 billable?

Accepted Answer

Yes. A36.86 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. A36.86 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for A36.86?

Accepted Answer

A36.86 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards A36.86 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting A36.86?

Accepted Answer

This code is part of the diphtheria family (A36.x codes) and should only be used when diphtheria bacteria is confirmed as the cause of the conjunctivitis, not for other bacterial causes of eye inflammation Verify documentation confirms diphtheritic etiology and conjunctival involvement; consider if additional codes are needed for systemic diphtheria manifestations (A36.0-A36.85) if present

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A36.86

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A36.86 ICD-10-CM Code: Diphtheritic conjunctivitis

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A36.86

Is A36.86 an HCC code?

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