Question 1

What is ICD-10 code H18.443?

Accepted Answer

H18.443 is the ICD-10-CM diagnosis code for keratomalacia, bilateral. Keratomalacia is a serious eye condition where both corneas become softened and cloudy, usually due to severe vitamin A deficiency. This can lead to corneal scarring and vision loss if not treated promptly. H18.443 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of sclera, cornea, iris and ciliary body (h15-h22).

H18.443 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.

Verify that the condition affects both eyes (bilateral) before assigning this code; if only one eye is affected, use the unilateral code (H18.441 or H18.442) instead.

Question 2

Is H18.443 an HCC code?

Accepted Answer

No. H18.443 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H18.443 billable?

Accepted Answer

Yes. H18.443 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. H18.443 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

What is the V28 vs V24 difference for H18.443?

Accepted Answer

H18.443 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards H18.443 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting H18.443?

Accepted Answer

Verify that the condition affects both eyes (bilateral) before assigning this code; if only one eye is affected, use the unilateral code (H18.441 or H18.442) instead Consider coding an additional diagnosis code for the underlying cause, such as vitamin A deficiency (E50.-), as this will support medical necessity and guide treatment decisions

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H18.443

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H18.443 ICD-10-CM Code: Keratomalacia, bilateral

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H18.443

Is H18.443 an HCC code?

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Work H18.443 in HCC Buddy