Question 1

What is ICD-10 code H20.013?

Accepted Answer

H20.013 is the ICD-10-CM diagnosis code for primary iridocyclitis, bilateral. The iris and ciliary body of both eyes are inflamed due to a primary cause (not secondary to another condition), developing suddenly or over a short period. H20.013 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).

H20.013 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.

Bilateral coding requires explicit documentation that both eyes are affected; do not assume bilateral involvement.

Question 2

Is H20.013 an HCC code?

Accepted Answer

No. H20.013 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 H20.013 billable?

Accepted Answer

Yes. H20.013 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. H20.013 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 H20.013?

Accepted Answer

H20.013 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 H20.013 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 H20.013?

Accepted Answer

Bilateral coding requires explicit documentation that both eyes are affected; do not assume bilateral involvement When bilateral iridocyclitis is present, code H20.013 once rather than coding each eye separately

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H20.013

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H20.013 ICD-10-CM Code: Primary iridocyclitis, bilateral

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H20.013

Is H20.013 an HCC code?

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