H11.019 ICD-10-CM Code: Amyloid pterygium of unspecified eye
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of conjunctiva (H10-H11)
H11.019
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAmyloid pterygium of unspecified eye
A pterygium is a growth of tissue on the eye's surface, and this code specifically indicates that the growth contains amyloid protein deposits and affects an eye that hasn't been specified as left or right. This is a rare condition where abnormal protein accumulates in the eye tissue.
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 H11.019 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H11.019 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H11.019 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H11.019 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H11.019 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H11.019 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H11.019 in this effective period.
Buddy Documentation Tip
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 →
Is H11.019 an HCC code?
No. H11.019 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- H11.019
- Description
- Amyloid pterygium of unspecified eye
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
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
H11.019 is the ICD-10-CM diagnosis code for amyloid pterygium of unspecified eye. A pterygium is a growth of tissue on the eye's surface, and this code specifically indicates that the growth contains amyloid protein deposits and affects an eye that hasn't been specified as left or right. This is a rare condition where abnormal protein accumulates in the eye tissue. H11.019 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).
H11.019 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.
When the documentation specifies which eye is affected (left or right), use the more specific codes H11.011 or H11.012 instead of the unspecified code H11.019.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H11.019 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •When the documentation specifies which eye is affected (left or right), use the more specific codes H11.011 or H11.012 instead of the unspecified code H11.019
- •Amyloid pterygium is distinct from typical pterygium (H11.00-H11.009), so ensure documentation clearly indicates amyloid involvement before assigning this code