H36 ICD-10-CM Code: Retinal disorders in diseases classified elsewhere
H36 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)
H36
Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidanceRetinal disorders in diseases classified elsewhere
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for H36. 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
- certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59
- diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59
- injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59
- neoplasms (C00-D49)Inherited from H00-H59
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59
- syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59
Related Codes
Includes
OfficialNo Includes notes are included in this display for H36. Check the code and parent instructions in the Code Book.
Excludes 1
Official- arteriosclerotic retinopathy (H35.0-)
- diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)
Code First
Official- underlying disease, such as:
- lipid storage disorders (E75.-)
- sickle-cell disorders (D57.-)
Use Additional
OfficialNo Use Additional Code instructions are included in this display for H36. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for H36. Check the code and parent instructions in the Code Book.
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 →
- Code
- H36
- Description
- Retinal disorders in diseases classified elsewhere
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- No
- Payment year
- 2026
Coder workflow notes
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What This Code Means
H36 is the ICD-10-CM diagnosis code for retinal disorders in diseases classified elsewhere. H36 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).
Header codes like H36 cannot be reported on claims directly; they organize child codes that share clinical context. Coders should select the billable child code that matches the documented presentation and then verify its current source-backed HCC mapping. Do not infer a child code or risk adjustment value from the header alone.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H36 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.