A54.31 ICD-10-CM Code: Gonococcal conjunctivitis
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FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Infections with a predominantly sexual mode of transmission (A50-A64)
A54.31
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceGonococcal conjunctivitis
This is an eye infection caused by gonorrhea bacteria that affects the conjunctiva (the clear membrane covering the white part of the eye and inner eyelids). It causes redness, swelling, and discharge from the infected eye.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Ophthalmia neonatorum due to gonococcus
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for A54.31 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for A54.31 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for A54.31 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for A54.31 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for A54.31 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for A54.31 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is A54.31 an HCC code?
No. A54.31 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
A54.31 is the ICD-10-CM diagnosis code for gonococcal conjunctivitis. This is an eye infection caused by gonorrhea bacteria that affects the conjunctiva (the clear membrane covering the white part of the eye and inner eyelids). It causes redness, swelling, and discharge from the infected eye. A54.31 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering infections with a predominantly sexual mode of transmission (a50-a64).
A54.31 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code is typically used for neonatal conjunctivitis acquired during birth from an infected mother; verify documentation specifies gonococcal etiology rather than other bacterial causes.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for A54.31 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is typically used for neonatal conjunctivitis acquired during birth from an infected mother; verify documentation specifies gonococcal etiology rather than other bacterial causes
- •Ensure you are not confusing this with other conjunctivitis codes (H10 series); A54.31 specifically indicates the gonococcal organism as the causative agent