Question 1

What is ICD-10 code H28?

Accepted Answer

H28 is the ICD-10-CM diagnosis code for cataract in diseases classified elsewhere. A cataract (clouding of the lens) that has developed as a result of another disease or medical condition. H28 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).

H28 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 requires a secondary diagnosis code for the underlying disease causing the cataract.

Question 2

Is H28 an HCC code?

Accepted Answer

No. H28 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 H28 billable?

Accepted Answer

Yes. H28 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. H28 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 H28?

Accepted Answer

H28 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 H28 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 H28?

Accepted Answer

This code requires a secondary diagnosis code for the underlying disease causing the cataract Common underlying conditions include diabetes, myotonic dystrophy, and hypoparathyroidism

HCC Buddy Code Card

H28

Is H28 an HCC code?

What This Code Means

Coding Tips

Excludes 1, Do NOT code together

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H28 ICD-10-CM Code: Cataract in diseases classified elsewhere

HCC Buddy Code Card

H28

Is H28 an HCC code?

What This Code Means

Coding Tips

Excludes 1, Do NOT code together

Code First

Code Hierarchy

Work H28 in HCC Buddy