H34.213 ICD-10-CM Code: Partial 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)
H34.213
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePartial retinal artery occlusion, bilateral
A condition where blood vessels in the retina (the light-sensitive tissue at the back of the eye) are partially blocked on both sides, reducing blood flow to the eye tissue. This can cause vision problems or vision loss if not treated promptly.
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
Code Trumping
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Code Book Path
Inclusion Terms
Official- Hollenhorst's plaque
- Retinal microembolism
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H34.213 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H34.213 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H34.213 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H34.213 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H34.213 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H34.213 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 H34.213 an HCC code?
No. H34.213 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
H34.213 is the ICD-10-CM diagnosis code for partial retinal artery occlusion, bilateral. A condition where blood vessels in the retina (the light-sensitive tissue at the back of the eye) are partially blocked on both sides, reducing blood flow to the eye tissue. This can cause vision problems or vision loss if not treated promptly. H34.213 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).
H34.213 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 documentation specifies 'bilateral' involvement before assigning this code; unilateral cases require different codes (H34.211 for right eye, H34.212 for left eye).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H34.213 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies 'bilateral' involvement before assigning this code; unilateral cases require different codes (H34.211 for right eye, H34.212 for left eye)
- •Ensure the retinal artery occlusion is documented as 'partial' rather than 'complete' or 'central' as these have distinct code assignments