Question 1

What is ICD-10 code H35.372?

Accepted Answer

H35.372 is the ICD-10-CM diagnosis code for puckering of macula, left eye. A wrinkling or puckering of the macula in the left eye, typically caused by scar tissue formation that distorts the central retina and affects vision. H35.372 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).

H35.372 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.

Puckering of macula is often a consequence of retinal surgery or epiretinal membrane; review operative reports.

Question 2

Is H35.372 an HCC code?

Accepted Answer

No. H35.372 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 H35.372 billable?

Accepted Answer

Yes. H35.372 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. H35.372 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 H35.372?

Accepted Answer

H35.372 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 H35.372 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 H35.372?

Accepted Answer

Puckering of macula is often a consequence of retinal surgery or epiretinal membrane; review operative reports Confirm this is macular puckering and not general retinal puckering

HCC Buddy Code Card

H35.372

Is H35.372 an HCC code?

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Open H35.372 in the Interactive Encoder

H35.372 ICD-10-CM Code: Puckering of macula, left eye

HCC Buddy Code Card

H35.372

Is H35.372 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H35.372 in the Interactive Encoder