Question 1

What is ICD-10 code H26.113?

Accepted Answer

H26.113 is the ICD-10-CM diagnosis code for localized traumatic opacities, bilateral. This code describes clouding or haziness of the lens in both eyes caused by trauma or injury. The opacity (cloudiness) is limited to a specific area of the lens rather than affecting the entire lens. H26.113 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).

H26.113 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Verify that the documentation specifies bilateral involvement (both eyes) before assigning this code; if only one eye is affected, use the unilateral code H26.111 instead.

Question 2

Is H26.113 an HCC code?

Accepted Answer

H26.113 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 3

Is H26.113 billable?

Accepted Answer

Yes. H26.113 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. H26.113 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

Which HCC does H26.113 map to under V28?

Accepted Answer

H26.113 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 5

What RAF reference is published for H26.113?

Accepted Answer

H26.113 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

Question 6

What is the V28 vs V24 difference for H26.113?

Accepted Answer

H26.113 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

Question 7

What documentation supports H26.113?

Accepted Answer

Verify that the documentation specifies bilateral involvement (both eyes) before assigning this code; if only one eye is affected, use the unilateral code H26.111 instead Ensure the opacities are documented as traumatic in origin and localized to a specific region; if the trauma is recent and acute, consider also coding the external cause code (W-codes) to indicate how the injury occurred H26.113 is not a CMS-HCC V28 payment code in the verified current source, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

Question 8

Can H26.113 be a primary diagnosis?

Accepted Answer

Yes. H26.113 carries no code-first instruction in the FY2026 tabular, so it can be the first-listed diagnosis when it is the condition chiefly responsible for the encounter and the note supports it, and it can also be reported as a secondary diagnosis. For risk adjustment the order does not matter; the V28 category is the same either way.

Question 9

Which codes cannot be reported with H26.113?

Accepted Answer

The Excludes1 note that applies to H26.113 lists congenital cataract (Q12.0). An Excludes1 condition is not reported together with H26.113; report one or the other, unless the two conditions are unrelated, which the ICD-10-CM Official Guidelines (Section I.A.12.a) allow. The Excludes2 note lists certain conditions originating in the perinatal period (P04-P96); certain infectious and parasitic diseases (A00-B99); complications of pregnancy, childbirth and the puerperium (O00-O9A); congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99); and 7 more (see the notes on this page); those are separate conditions that may be reported together with H26.113 when both are documented.

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H26.113

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H26.113 ICD-10-CM Code: Localized traumatic opacities, bilateral

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H26.113

Is H26.113 an HCC code?

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What This Code Means

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Also searched as

Work H26.113 in HCC Buddy