H34.13 ICD-10-CM Code: Central retinal artery occlusion, bilateral
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)
H34.13
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCentral retinal artery occlusion, bilateral
A blockage of the main artery supplying blood to the retina affecting both eyes simultaneously, causing vision loss in both eyes.
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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Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H34.13 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H34.13 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H34.13 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H34.13 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H34.13 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H34.13 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H34.13 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 H34.13 an HCC code?
No. H34.13 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
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
H34.13 is the ICD-10-CM diagnosis code for central retinal artery occlusion, bilateral. A blockage of the main artery supplying blood to the retina affecting both eyes simultaneously, causing vision loss in both eyes. H34.13 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).
H34.13 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.
Bilateral codes require documentation confirming involvement of both eyes; do not assume bilateral without explicit confirmation.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H34.13 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Bilateral codes require documentation confirming involvement of both eyes; do not assume bilateral without explicit confirmation
- •This rare presentation may indicate systemic vascular disease and warrants investigation for underlying causes