Question 1

What is ICD-10 code H35.411?

Accepted Answer

H35.411 is the ICD-10-CM diagnosis code for lattice degeneration of retina, right eye. A pattern of retinal thinning in the outer edges of the right eye that creates a lattice-like appearance and may lead to retinal holes or detachment. H35.411 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).

H35.411 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.

Confirm right eye laterality is documented; do not assume if not explicitly stated.

Question 2

Is H35.411 an HCC code?

Accepted Answer

No. H35.411 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 H35.411 billable?

Accepted Answer

Yes. H35.411 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. H35.411 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 H35.411?

Accepted Answer

H35.411 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 H35.411 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 H35.411?

Accepted Answer

Confirm right eye laterality is documented; do not assume if not explicitly stated Note any associated retinal holes or detachments and code separately if present

HCC Buddy Code Card

H35.411

Is H35.411 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H35.411 in the Interactive Encoder

H35.411 ICD-10-CM Code: Lattice degeneration of retina, right eye

HCC Buddy Code Card

H35.411

Is H35.411 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H35.411 in the Interactive Encoder