Question 1

What is ICD-10 code H26.413?

Accepted Answer

H26.413 is the ICD-10-CM diagnosis code for soemmering's ring, bilateral. Soemmering's ring is a type of cataract where lens fibers accumulate in a ring-like formation around the edge of the lens after cataract surgery. This code indicates the condition is present in both eyes. H26.413 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).

H26.413 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.

This code is used specifically when Soemmering's ring is documented as bilateral (both eyes); use H26.411 for right eye only or H26.412 for left eye only.

Question 2

Is H26.413 an HCC code?

Accepted Answer

No. H26.413 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 H26.413 billable?

Accepted Answer

Yes. H26.413 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. H26.413 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 H26.413?

Accepted Answer

H26.413 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 H26.413 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 H26.413?

Accepted Answer

This code is used specifically when Soemmering's ring is documented as bilateral (both eyes); use H26.411 for right eye only or H26.412 for left eye only Soemmering's ring typically develops as a post-operative complication following cataract extraction, so review operative reports and ensure the relationship to prior cataract surgery is documented

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H26.413

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H26.413 ICD-10-CM Code: Soemmering's ring, bilateral

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H26.413

Is H26.413 an HCC code?

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Open H26.413 in the Interactive Encoder