Question 1

What is ICD-10 code H11.013?

Accepted Answer

H11.013 is the ICD-10-CM diagnosis code for Amyloid pterygium of eye, bilateral. It belongs to the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59). H11.013 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H11.013 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 H11.013 an HCC code?

Accepted Answer

H11.013 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 3

Is H11.013 billable?

Accepted Answer

Yes. H11.013 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. H11.013 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

Which HCC does H11.013 map to under V28?

Accepted Answer

H11.013 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 5

What RAF reference is published for H11.013?

Accepted Answer

H11.013 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

Question 6

What is the V28 vs V24 difference for H11.013?

Accepted Answer

H11.013 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

Question 7

What documentation supports H11.013?

Accepted Answer

Verify that the pterygium is confirmed to be amyloid type through pathology or clinical documentation before coding H11.013, as this is a specific histological diagnosis Ensure bilateral involvement is documented in the medical record; if only one eye is affected, use H11.011 (right eye) or H11.012 (left eye) instead H11.013 is not a CMS-HCC V28 payment code in the verified current source, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

Question 8

Can H11.013 be a primary diagnosis?

Accepted Answer

Yes. H11.013 carries no code-first instruction in the FY2026 tabular, so it can be the first-listed diagnosis when it is the condition chiefly responsible for the encounter and the note supports it, and it can also be reported as a secondary diagnosis. For risk adjustment the order does not matter; the V28 category is the same either way.

Question 9

Which codes cannot be reported with H11.013?

Accepted Answer

The Excludes1 note that applies to H11.013 lists keratoconjunctivitis (H16.2-); pseudopterygium (H11.81-). An Excludes1 condition is not reported together with H11.013; report one or the other, unless the two conditions are unrelated, which the ICD-10-CM Official Guidelines (Section I.A.12.a) allow. The Excludes2 note lists certain conditions originating in the perinatal period (P04-P96); certain infectious and parasitic diseases (A00-B99); complications of pregnancy, childbirth and the puerperium (O00-O9A); congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99); and 7 more (see the notes on this page); those are separate conditions that may be reported together with H11.013 when both are documented.

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H11.013

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H11.013 ICD-10-CM Code: Amyloid pterygium of eye, bilateral

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H11.013

Is H11.013 an HCC code?

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What This Code Means

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Work H11.013 in HCC Buddy