Question 1

What is ICD-10 code H33.002?

Accepted Answer

H33.002 is the ICD-10-CM diagnosis code for unspecified retinal detachment with retinal break, left eye. The retina has separated from the back of the eye with a tear or hole in the retina, affecting the left eye. H33.002 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).

H33.002 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.

Verify that a retinal break (tear or hole) is documented; this distinguishes it from other types of detachment.

Question 2

Is H33.002 an HCC code?

Accepted Answer

No. H33.002 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 H33.002 billable?

Accepted Answer

Yes. H33.002 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. H33.002 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 H33.002?

Accepted Answer

H33.002 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 community model rewards H33.002 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 5

What should coders know when reporting H33.002?

Accepted Answer

Verify that a retinal break (tear or hole) is documented; this distinguishes it from other types of detachment Confirm laterality as left eye; use H33.001 for right eye or H33.003 for bilateral involvement

HCC Buddy Code Card

H33.002

Is H33.002 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H33.002 in HCC Buddy

H33.002 ICD-10-CM Code: Unspecified retinal detachment with retinal break, left eye

HCC Buddy Code Card

H33.002

Is H33.002 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H33.002 in HCC Buddy