What is ICD-10 code H31.011?

H31.011 is the ICD-10-CM diagnosis code for Macula scars of posterior pole (postinflammatory) (post-traumatic), right eye. Scarring of the macula (central area of the retina) in the right eye resulting from previous inflammation or trauma. H31.011 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H31.011 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. H31.011 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. H31.011 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.

Which HCC does H31.011 map to under V28?

H31.011 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

What RAF reference is published for H31.011?

H31.011 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

What is the V28 vs V24 difference for H31.011?

H31.011 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

2026 ICD-10-CM H31.011: Macula scars of posterior pole

H31.011 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupH31.011

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)

H31.011

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Macula scars of posterior pole (postinflammatory) (post-traumatic), right eye

Scarring of the macula (central area of the retina) in the right eye resulting from previous inflammation or trauma.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

H31.0Chorioretinal scars H31.01Macula scars of posterior pole (postinflammatory) (post-traumatic)H31.011Macula scars of posterior pole (postinflammatory) (post-traumatic), right eye

Inclusion Terms

Official

No inclusion terms are included in this display for H31.011. Check the code and parent instructions in the Code Book.

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59, H31.0
certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59, H31.0
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59, H31.0
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59, H31.0
diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59, H31.0
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59, H31.0
injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59, H31.0
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59, H31.0
neoplasms (C00-D49)Inherited from H00-H59, H31.0
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59, H31.0
syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59, H31.0
postsurgical chorioretinal scars (H59.81-)Inherited from H00-H59, H31.0

Related Codes

Official

H31.012Macula scars of posterior pole (postinflammatory) (post-traumatic), left eye H31.013Macula scars of posterior pole (postinflammatory) (post-traumatic), bilateral H31.019Macula scars of posterior pole (postinflammatory) (post-traumatic), unspecified eye

Includes

Official

No Includes notes are included in this display for H31.011. Check the code and parent instructions in the Code Book.

Excludes 1

Official

postprocedural choriorentinal scar (H59.81-)Inherited from H31.01

Code First

Official

No Code First sequencing instructions are included in this display for H31.011. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for H31.011. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for H31.011. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

This code specifies macula involvement and post-inflammatory or post-traumatic etiology; ensure documentation supports this location and cause

Macula scars can significantly impact vision; document visual acuity findings when available

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is H31.011 an HCC code?

No. H31.011 is a billable ICD-10-CM code with no mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: H31.011
Description: Macula scars of posterior pole (postinflammatory) (post-traumatic), right eye
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).

What This Code Means

H31.011 is the ICD-10-CM diagnosis code for macula scars of posterior pole (postinflammatory) (post-traumatic), right eye. Scarring of the macula (central area of the retina) in the right eye resulting from previous inflammation or trauma. H31.011 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).

H31.011 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.

This code specifies macula involvement and post-inflammatory or post-traumatic etiology; ensure documentation supports this location and cause.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H31.011 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code specifies macula involvement and post-inflammatory or post-traumatic etiology; ensure documentation supports this location and cause
•Macula scars can significantly impact vision; document visual acuity findings when available