Question 1

What is ICD-10 code H30.142?

Accepted Answer

H30.142 is the ICD-10-CM diagnosis code for acute posterior multifocal placoid pigment epitheliopathy, left eye. A sudden inflammatory condition affecting the back of the left eye, characterized by multiple small, flat, pigmented lesions on the light-sensitive tissue. H30.142 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of choroid and retina (h30-h36).

H30.142 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 is an acute condition requiring documentation of laterality; ensure left eye is clearly specified in the medical record.

Question 2

Is H30.142 an HCC code?

Accepted Answer

No. H30.142 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 H30.142 billable?

Accepted Answer

Yes. H30.142 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. H30.142 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 H30.142?

Accepted Answer

H30.142 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 H30.142 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 H30.142?

Accepted Answer

This is an acute condition requiring documentation of laterality; ensure left eye is clearly specified in the medical record Often associated with viral infections; review clinical notes for any preceding systemic illness or viral exposure

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H30.142

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H30.142 ICD-10-CM Code: Acute posterior multifocal placoid pigment epitheliopathy, left eye

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H30.142

Is H30.142 an HCC code?

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Work H30.142 in HCC Buddy