Question 1

What is ICD-10 code H31.019?

Accepted Answer

H31.019 is the ICD-10-CM diagnosis code for macula scars of posterior pole (postinflammatory) (post-traumatic), unspecified eye. Scarring of the macula (central area of the retina) resulting from previous inflammation or trauma in an eye where the specific eye location is not documented. H31.019 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).

H31.019 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.

Use this code only when eye laterality is not specified; attempt to determine from clinical documentation if right eye, left eye, or bilateral coding applies.

Question 2

Is H31.019 an HCC code?

Accepted Answer

No. H31.019 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 H31.019 billable?

Accepted Answer

Yes. H31.019 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. H31.019 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 H31.019?

Accepted Answer

H31.019 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 H31.019 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 H31.019?

Accepted Answer

Use this code only when eye laterality is not specified; attempt to determine from clinical documentation if right eye, left eye, or bilateral coding applies Macula involvement is clinically significant; ensure the eye location is clarified for proper patient care tracking

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H31.019

Is H31.019 an HCC code?

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H31.019 ICD-10-CM Code: Macula scars of posterior pole (postinflammatory) (post-traumatic), unspecified eye

HCC Buddy Code Card

H31.019

Is H31.019 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H31.019 in the Interactive Encoder