H31.313 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupH31.313

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)

H31.313

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

Expulsive choroidal hemorrhage, bilateral

Expulsive choroidal hemorrhage affecting both eyes is a serious condition where bleeding in the choroid layer causes sudden expansion in both eyes, potentially pushing the retina forward.

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

H31.3Choroidal hemorrhage and rupture H31.31Expulsive choroidal hemorrhage H31.313Expulsive choroidal hemorrhage, bilateral

Inclusion Terms

Official

No inclusion terms are included in this display for H31.313. 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
certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59
diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59
injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59
neoplasms (C00-D49)Inherited from H00-H59
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59
syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59

Related Codes

Official

H31.311Expulsive choroidal hemorrhage, right eye H31.312Expulsive choroidal hemorrhage, left eye H31.319Expulsive choroidal hemorrhage, unspecified eye

Includes

Official

No Includes notes are included in this display for H31.313. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for H31.313. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for H31.313. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for H31.313. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for H31.313. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

This bilateral presentation is rare; document the clinical circumstances and any triggering events

Ensure both eyes are documented as affected in the medical record

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 H31.313 an HCC code?

No. H31.313 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: H31.313
Description: Expulsive choroidal hemorrhage, bilateral
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

H31.313 is the ICD-10-CM diagnosis code for expulsive choroidal hemorrhage, bilateral. Expulsive choroidal hemorrhage affecting both eyes is a serious condition where bleeding in the choroid layer causes sudden expansion in both eyes, potentially pushing the retina forward. H31.313 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).

H31.313 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, 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 bilateral presentation is rare; document the clinical circumstances and any triggering events.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H31.313 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This bilateral presentation is rare; document the clinical circumstances and any triggering events
•Ensure both eyes are documented as affected in the medical record