Question 1

What is ICD-10 code H34.231?

Accepted Answer

H34.231 is the ICD-10-CM diagnosis code for retinal artery branch occlusion, right eye. A blockage of a branch of the retinal artery in the right eye, affecting blood flow to a specific area of the retina. H34.231 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).

H34.231 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.

Branch retinal artery occlusion (BRAO) typically affects a sector of vision rather than the entire visual field.

Question 2

Is H34.231 an HCC code?

Accepted Answer

No. H34.231 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 H34.231 billable?

Accepted Answer

Yes. H34.231 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. H34.231 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 H34.231?

Accepted Answer

H34.231 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 model rewards H34.231 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting H34.231?

Accepted Answer

Branch retinal artery occlusion (BRAO) typically affects a sector of vision rather than the entire visual field Document which branch is affected (superior, inferior, temporal, nasal) if available for complete clinical picture

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H34.231

Is H34.231 an HCC code?

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H34.231 ICD-10-CM Code: Retinal artery branch occlusion, right eye

HCC Buddy Code Card

H34.231

Is H34.231 an HCC code?

What This Code Means

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Child Codes

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Open H34.231 in the Interactive Encoder