Question 1

What is ICD-10 code H18.731?

Accepted Answer

H18.731 is the ICD-10-CM diagnosis code for descemetocele, right eye. A condition where the innermost layer of the cornea (Descemet's membrane) protrudes forward, creating a blister-like bulge in the right eye. H18.731 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).

H18.731 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.

Descemetocele is a serious condition indicating corneal thinning; ensure documentation specifies right eye laterality.

Question 2

Is H18.731 an HCC code?

Accepted Answer

No. H18.731 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 H18.731 billable?

Accepted Answer

Yes. H18.731 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. H18.731 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 H18.731?

Accepted Answer

H18.731 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 H18.731 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 H18.731?

Accepted Answer

Descemetocele is a serious condition indicating corneal thinning; ensure documentation specifies right eye laterality This condition often requires urgent ophthalmologic evaluation and may lead to corneal perforation if untreated

HCC Buddy Code Card

H18.731

Is H18.731 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H18.731 in HCC Buddy

H18.731 ICD-10-CM Code: Descemetocele, right eye

HCC Buddy Code Card

H18.731

Is H18.731 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H18.731 in HCC Buddy