Question 1

What is ICD-10 code H34.219?

Accepted Answer

H34.219 is the ICD-10-CM diagnosis code for partial retinal artery occlusion, unspecified eye. A partial blockage of a retinal artery branch when the specific eye affected is not documented or specified. H34.219 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).

H34.219 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.

Use unspecified codes only when laterality cannot be determined from documentation; query provider if possible.

Question 2

Is H34.219 an HCC code?

Accepted Answer

No. H34.219 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 H34.219 billable?

Accepted Answer

Yes. H34.219 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. H34.219 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 H34.219?

Accepted Answer

H34.219 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 H34.219 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 H34.219?

Accepted Answer

Use unspecified codes only when laterality cannot be determined from documentation; query provider if possible Unspecified codes should be avoided when documentation allows for more specific coding

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H34.219

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H34.219 ICD-10-CM Code: Partial retinal artery occlusion, unspecified eye

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H34.219

Is H34.219 an HCC code?

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What This Code Means

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Work H34.219 in HCC Buddy