Question 1

What is ICD-10 code H20.11?

Accepted Answer

H20.11 is the ICD-10-CM diagnosis code for chronic iridocyclitis, right eye. Long-term inflammation of the iris and ciliary body in the right eye, causing potential vision problems and eye discomfort. H20.11 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).

H20.11 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.

Document the underlying etiology (such as sarcoidosis, tuberculosis, or autoimmune disease) with an additional code.

Question 2

Is H20.11 an HCC code?

Accepted Answer

No. H20.11 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 H20.11 billable?

Accepted Answer

Yes. H20.11 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. H20.11 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 H20.11?

Accepted Answer

H20.11 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 H20.11 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 H20.11?

Accepted Answer

Document the underlying etiology (such as sarcoidosis, tuberculosis, or autoimmune disease) with an additional code Chronic iridocyclitis may require ongoing treatment; note any complications like posterior synechiae or cataracts

HCC Buddy Code Card

H20.11

Is H20.11 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H20.11 in HCC Buddy

H20.11 ICD-10-CM Code: Chronic iridocyclitis, right eye

HCC Buddy Code Card

H20.11

Is H20.11 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H20.11 in HCC Buddy