Question 1

What is ICD-10 code H25.813?

Accepted Answer

H25.813 is the ICD-10-CM diagnosis code for combined forms of age-related cataract, bilateral. A combination of different types of age-related cataracts affecting both eyes, where multiple cataract patterns are present simultaneously in each eye. H25.813 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of lens (h25-h28).

H25.813 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.

Combined forms indicate multiple cataract types; use this code only when documented as bilateral.

Question 2

Is H25.813 an HCC code?

Accepted Answer

No. H25.813 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 H25.813 billable?

Accepted Answer

Yes. H25.813 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. H25.813 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 H25.813?

Accepted Answer

H25.813 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 H25.813 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 H25.813?

Accepted Answer

Combined forms indicate multiple cataract types; use this code only when documented as bilateral Do not use if only one eye is affected; use H25.811 or H25.812 instead

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H25.813

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H25.813 ICD-10-CM Code: Combined forms of age-related cataract, bilateral

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H25.813

Is H25.813 an HCC code?

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