H11.033 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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Code lookupH11.033

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

H11.033

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Double pterygium of eye, bilateral

A pterygium is a growth of tissue on the white part of the eye that can affect vision. This code indicates the patient has two pterygiums on each eye (bilateral), meaning both eyes are affected with multiple growths.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

H11.0Pterygium of eye H11.03Double pterygium of eye H11.033Double pterygium of eye, bilateral

Inclusion Terms

Official

No inclusion terms are included in this display for H11.033. Check the code and parent instructions in the Code Book.

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59
certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59
diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59
injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59
neoplasms (C00-D49)Inherited from H00-H59
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59
syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59

Related Codes

Official

H11.031Double pterygium of right eye H11.032Double pterygium of left eye H11.039Double pterygium of unspecified eye

Includes

Official

No Includes notes are included in this display for H11.033. Check the code and parent instructions in the Code Book.

Excludes 1

Official

keratoconjunctivitis (H16.2-)Inherited from H11, H11.0
pseudopterygium (H11.81-)Inherited from H11, H11.0

Code First

Official

No Code First sequencing instructions are included in this display for H11.033. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for H11.033. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for H11.033. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Verify documentation specifies 'bilateral' and 'double' pterygium before assigning this code; if only one eye is affected or only one pterygium per eye, use a different H11.03x code

This code is specific to bilateral involvement, so confirm both eyes are documented in the clinical record to support accurate coding

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 H11.033 an HCC code?

No. H11.033 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: H11.033
Description: Double pterygium of eye, bilateral
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

H11.033 is the ICD-10-CM diagnosis code for double pterygium of eye, bilateral. A pterygium is a growth of tissue on the white part of the eye that can affect vision. This code indicates the patient has two pterygiums on each eye (bilateral), meaning both eyes are affected with multiple growths. H11.033 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).

H11.033 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Verify documentation specifies 'bilateral' and 'double' pterygium before assigning this code; if only one eye is affected or only one pterygium per eye, use a different H11.03x code.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H11.033 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify documentation specifies 'bilateral' and 'double' pterygium before assigning this code; if only one eye is affected or only one pterygium per eye, use a different H11.03x code
•This code is specific to bilateral involvement, so confirm both eyes are documented in the clinical record to support accurate coding