D31.20 ICD-10-CM Code: Benign neoplasm of unspecified retina
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Neoplasms (C00-D49) / Benign neoplasms, except benign neuroendocrine tumors (D10-D36)
D31.20
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBenign neoplasm of unspecified retina
A non-cancerous growth on the retina (the light-sensitive tissue at the back of the eye), but the specific eye is not documented.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for D31.20 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for D31.20 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for D31.20 in this effective period.
Excludes 1
Official- dark area on retina (D49.81)
- hemangioma of retina (D49.81)
- neoplasm of unspecified behavior of retina and choroid (D49.81)
- retinal freckle (D49.81)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D31.20 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D31.20 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for D31.20 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 D31.20 an HCC code?
No. D31.20 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- D31.20
- Description
- Benign neoplasm of unspecified retina
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
Get the V28 RAF + MEAT cheat sheet
One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.
Free PDF. No card. Unsubscribe anytime.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
D31.20 is the ICD-10-CM diagnosis code for benign neoplasm of unspecified retina. A non-cancerous growth on the retina (the light-sensitive tissue at the back of the eye), but the specific eye is not documented. D31.20 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering benign neoplasms, except benign neuroendocrine tumors (d10-d36).
D31.20 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.
Always query for laterality as retinal lesions require specification of which eye is affected.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D31.20 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always query for laterality as retinal lesions require specification of which eye is affected
- •Distinguish between retinal nevi, hemangiomas, and other benign retinal lesions