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H11 ICD-10-CM Code: Other disorders of conjunctiva

H11 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC Buddy coding tools

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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of conjunctiva (H10-H11)

H11

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Other disorders of conjunctiva

Other disorders of conjunctiva

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

Official
H1Disorders of conjunctiva (H10-H11)
H11Other disorders of conjunctiva

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for H11 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for H11 in this effective period.

Related Child Codes

Official
H11.0Pterygium of eye
H11.1Conjunctival degenerations and deposits
H11.2Conjunctival scars
H11.3Conjunctival hemorrhage
H11.4Other conjunctival vascular disorders and cysts

Includes

Official

ICD-10-CM does not list Includes notes for H11 in this effective period.

Excludes 1

Official
  • keratoconjunctivitis (H16.2-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for H11 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for H11 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for H11 in this effective period.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Code
H11
Description
Other disorders of conjunctiva
HCC (V28)
No CMS-HCC V28 mapping
RAF
Billable
No
Payment year
2026

Coder workflow notes

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What This Code Means

H11 is the ICD-10-CM diagnosis code for other disorders of conjunctiva. H11 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of conjunctiva (h10-h11).

Header codes like H11 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at H11's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Excludes 1, Do NOT code together

  • keratoconjunctivitis (H16.2-)

Child Codes

Code Hierarchy

H11Other disorders of conjunctiva
H11Other disorders of conjunctiva

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