Question 1

What is ICD-10 code H26.31?

Accepted Answer

H26.31 is the ICD-10-CM diagnosis code for drug-induced cataract, right eye. Clouding of the lens in the right eye caused by medications or drugs the patient has taken. H26.31 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).

H26.31 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.

Always identify and document the specific drug causing the cataract; use an additional code from category T36-T50 with fifth or sixth character indicating adverse effect.

Question 2

Is H26.31 an HCC code?

Accepted Answer

H26.31 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 3

Is H26.31 billable?

Accepted Answer

Yes. H26.31 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. H26.31 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 H26.31 map to under V28?

Accepted Answer

H26.31 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 5

What RAF reference is published for H26.31?

Accepted Answer

H26.31 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 H26.31?

Accepted Answer

H26.31 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 H26.31?

Accepted Answer

Always identify and document the specific drug causing the cataract; use an additional code from category T36-T50 with fifth or sixth character indicating adverse effect Ensure laterality is correctly specified as right eye only; do not use this code for bilateral cases H26.31 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.

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H26.31

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H26.31 ICD-10-CM Code: Drug-induced cataract, right eye

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H26.31

Is H26.31 an HCC code?

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What This Code Means

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Work H26.31 in HCC Buddy