H35.042 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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Code lookupH35.042

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)

H35.042

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Retinal micro-aneurysms, unspecified, left eye

Small bulges in the tiny blood vessels of the retina in the left eye, which can leak fluid or blood.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

H35.0Background retinopathy and retinal vascular changes H35.04Retinal micro-aneurysms, unspecified H35.042Retinal micro-aneurysms, unspecified, left eye

Inclusion Terms

Official

No inclusion terms are included in this display for H35.042. Check the code and parent instructions in the Code Book.

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59, H35
certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59, H35
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59, H35
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59, H35
diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59, H35
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59, H35
injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59, H35
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59, H35
neoplasms (C00-D49)Inherited from H00-H59, H35
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59, H35
syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59, H35
diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)Inherited from H00-H59, H35

Related Codes

Official

H35.041Retinal micro-aneurysms, unspecified, right eye H35.043Retinal micro-aneurysms, unspecified, bilateral H35.049Retinal micro-aneurysms, unspecified, unspecified eye

Includes

Official

No Includes notes are included in this display for H35.042. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for H35.042. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for H35.042. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for H35.042. Check the code and parent instructions in the Code Book.

Code Also

Official

any associated hypertension (I10)Inherited from H35.0

Buddy Documentation Tip

HCC Buddy guidance

Document the underlying etiology (diabetes, hypertension, etc.) for complete coding

Confirm left eye involvement is clearly stated in the clinical documentation

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is H35.042 an HCC code?

No. H35.042 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: H35.042
Description: Retinal micro-aneurysms, unspecified, left eye
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

H35.042 is the ICD-10-CM diagnosis code for retinal micro-aneurysms, unspecified, left eye. Small bulges in the tiny blood vessels of the retina in the left eye, which can leak fluid or blood. H35.042 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).

H35.042 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Document the underlying etiology (diabetes, hypertension, etc.) for complete coding.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H35.042 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the underlying etiology (diabetes, hypertension, etc.) for complete coding
•Confirm left eye involvement is clearly stated in the clinical documentation