Question 1

What is ICD-10 code H18.813?

Accepted Answer

H18.813 is the ICD-10-CM diagnosis code for anesthesia and hypoesthesia of cornea, bilateral. Loss of sensation or reduced feeling in the cornea of both eyes, affecting the ability to feel touch or pain in the clear front surface of the eyes. H18.813 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).

H18.813 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.

Confirm bilateral involvement is explicitly documented before assigning this code.

Question 2

Is H18.813 an HCC code?

Accepted Answer

No. H18.813 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 H18.813 billable?

Accepted Answer

Yes. H18.813 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. H18.813 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 H18.813?

Accepted Answer

H18.813 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 H18.813 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 H18.813?

Accepted Answer

Confirm bilateral involvement is explicitly documented before assigning this code Consider if this is part of a systemic condition affecting both eyes that should be coded separately

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H18.813

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H18.813 ICD-10-CM Code: Anesthesia and hypoesthesia of cornea, bilateral

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H18.813

Is H18.813 an HCC code?

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