H33.191 ICD-10-CM Code: Other retinoschisis and retinal cysts, right eye
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)
H33.191
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther retinoschisis and retinal cysts, right eye
This condition involves abnormal splitting or separation of layers within the retina (the light-sensitive tissue at the back of the eye) or the formation of fluid-filled sacs in the retina of the right eye. These changes can affect vision depending on their location and severity.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Code Book Path
Inclusion Terms
Official- Pseudocyst of retina
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H33.191 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H33.191 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H33.191 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H33.191 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H33.191 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H33.191 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H33.191 an HCC code?
No. H33.191 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H33.191 is the ICD-10-CM diagnosis code for other retinoschisis and retinal cysts, right eye. This condition involves abnormal splitting or separation of layers within the retina (the light-sensitive tissue at the back of the eye) or the formation of fluid-filled sacs in the retina of the right eye. These changes can affect vision depending on their location and severity. H33.191 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).
H33.191 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 laterality is documented as right eye only; if bilateral, use separate codes for each eye (H33.192 for left eye).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H33.191 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify laterality is documented as right eye only; if bilateral, use separate codes for each eye (H33.192 for left eye)
- •Distinguish between retinoschisis (layer separation) and retinal cysts (fluid-filled cavities) in the documentation, as this affects clinical management and monitoring