H11.069 ICD-10-CM Code: Recurrent pterygium of unspecified eye
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of conjunctiva (H10-H11)
H11.069
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceRecurrent pterygium of unspecified eye
A tissue growth on the white part of the eye that has returned or regrown after previous treatment, 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 H11.069 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H11.069 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H11.069 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H11.069 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H11.069 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H11.069 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H11.069 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 H11.069 an HCC code?
No. H11.069 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- H11.069
- Description
- Recurrent 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
H11.069 is the ICD-10-CM diagnosis code for recurrent pterygium of unspecified eye. A tissue growth on the white part of the eye that has returned or regrown after previous treatment, but the specific eye is not documented. H11.069 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).
H11.069 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.
Use only when laterality is not specified in documentation.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H11.069 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when laterality is not specified in documentation
- •Attempt to clarify with provider whether right, left, or both eyes are affected