Question 1

What is ICD-10 code H34.823?

Accepted Answer

H34.823 is the ICD-10-CM diagnosis code for venous engorgement, bilateral. This condition occurs when blood vessels in both eyes become swollen and filled with excess blood, causing the veins to appear enlarged and congested. It typically results from impaired blood drainage from the eye. H34.823 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).

H34.823 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 that the condition is documented as bilateral (affecting both eyes) before assigning this code; if only one eye is affected, use the unilateral code H34.821 instead.

Question 2

Is H34.823 an HCC code?

Accepted Answer

No. H34.823 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 H34.823 billable?

Accepted Answer

Yes. H34.823 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. H34.823 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

Which HCC does H34.823 map to under V28?

Accepted Answer

H34.823 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does H34.823 pay in RAF?

Accepted Answer

H34.823 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for H34.823?

Accepted Answer

H34.823 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 H34.823 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 7

What documentation supports H34.823?

Accepted Answer

Verify that the condition is documented as bilateral (affecting both eyes) before assigning this code; if only one eye is affected, use the unilateral code H34.821 instead Investigate and document the underlying cause of venous engorgement, such as cavernous sinus thrombosis, orbital tumors, or retinal vein occlusion, as this may require additional coding H34.823 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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H34.823

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H34.823 ICD-10-CM Code: Venous engorgement, bilateral

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H34.823

Is H34.823 an HCC code?

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