H33.313 ICD-10-CM Code: Horseshoe tear of retina without detachment, bilateral
H33.313 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)
H33.313
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHorseshoe tear of retina without detachment, bilateral
A horseshoe-shaped tear in the retina (the light-sensitive tissue at the back of the eye) that affects both eyes but has not yet caused the retina to separate from the eye wall. This type of tear has a characteristic horseshoe or U-shaped appearance and requires monitoring to prevent retinal detachment.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Operculum of retina without detachmentInherited from H33.31
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59, H33.3
- certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59, H33.3
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59, H33.3
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59, H33.3
- diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59, H33.3
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59, H33.3
- injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59, H33.3
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59, H33.3
- neoplasms (C00-D49)Inherited from H00-H59, H33.3
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59, H33.3
- syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59, H33.3
- peripheral retinal degeneration without break (H35.4-)Inherited from H00-H59, H33.3
Related Codes
Includes
OfficialNo Includes notes are included in this display for H33.313. Check the code and parent instructions in the Code Book.
Excludes 1
Official- detachment of retinal pigment epithelium (H35.72-, H35.73-)Inherited from H33, H33.3
- chorioretinal scars after surgery for detachment (H59.81-)Inherited from H33, H33.3
Code First
OfficialNo Code First sequencing instructions are included in this display for H33.313. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for H33.313. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for H33.313. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
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 H33.313 an HCC code?
No. H33.313 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
- H33.313
- Description
- Horseshoe tear of retina without detachment, bilateral
- 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
H33.313 is the ICD-10-CM diagnosis code for horseshoe tear of retina without detachment, bilateral. A horseshoe-shaped tear in the retina (the light-sensitive tissue at the back of the eye) that affects both eyes but has not yet caused the retina to separate from the eye wall. This type of tear has a characteristic horseshoe or U-shaped appearance and requires monitoring to prevent retinal detachment. H33.313 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).
H33.313 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.
Verify that the documentation specifically states 'without detachment' and confirms bilateral involvement before assigning this code; if detachment is present, use a different code from the H33.2 category.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H33.313 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that the documentation specifically states 'without detachment' and confirms bilateral involvement before assigning this code; if detachment is present, use a different code from the H33.2 category
- •Ensure the ophthalmology report clearly identifies the tear as horseshoe-shaped and documents that both eyes are affected; if only one eye is involved, use the unilateral code H33.311 instead