Question 1

What is ICD-10 code H35.461?

Accepted Answer

H35.461 is the ICD-10-CM diagnosis code for secondary vitreoretinal degeneration, right eye. A degenerative condition affecting both the retina and vitreous (gel-like substance) in the right eye that develops as a secondary effect of another condition. H35.461 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).

H35.461 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.

Identify the underlying cause of the secondary vitreoretinal degeneration and code it as the primary diagnosis.

Question 2

Is H35.461 an HCC code?

Accepted Answer

No. H35.461 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 H35.461 billable?

Accepted Answer

Yes. H35.461 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. H35.461 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 H35.461?

Accepted Answer

H35.461 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 H35.461 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 H35.461?

Accepted Answer

Identify the underlying cause of the secondary vitreoretinal degeneration and code it as the primary diagnosis Ensure right eye laterality is clearly documented in the medical record

HCC Buddy Code Card

H35.461

Is H35.461 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H35.461 in the Interactive Encoder

H35.461 ICD-10-CM Code: Secondary vitreoretinal degeneration, right eye

HCC Buddy Code Card

H35.461

Is H35.461 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H35.461 in the Interactive Encoder