Question 1

What is ICD-10 code H21.353?

Accepted Answer

H21.353 is the ICD-10-CM diagnosis code for exudative cyst of pars plana, bilateral. Fluid-filled sacs in the back part of the eye (pars plana) affecting both eyes. These cysts contain clear fluid and can develop from eye inflammation or injury. H21.353 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).

H21.353 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 documentation confirms bilateral involvement; if only one eye is affected, use H21.351 or H21.352 instead.

Question 2

Is H21.353 an HCC code?

Accepted Answer

No. H21.353 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 H21.353 billable?

Accepted Answer

Yes. H21.353 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. H21.353 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 H21.353?

Accepted Answer

H21.353 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 H21.353 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 H21.353?

Accepted Answer

Verify documentation confirms bilateral involvement; if only one eye is affected, use H21.351 or H21.352 instead Document the underlying cause if present, such as prior uveitis or trauma, for more complete coding

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H21.353

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H21.353 ICD-10-CM Code: Exudative cyst of pars plana, bilateral

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H21.353

Is H21.353 an HCC code?

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Work H21.353 in HCC Buddy