FY2027 ICD-10-CM reference
H36.813: Nonproliferative sickle-cell retinopathy, bilateral
By the HCC Buddy Coding Team
The official ICD-10-CM descriptor is Nonproliferative sickle-cell retinopathy, bilateral. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Billable code. Verified against the official FY2027 order file.
FY2027 Tabular instructions
Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.
Instructional note
Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition
Source: H00-H59 (chapter, inherited).
Excludes2
certain conditions originating in the perinatal period (P04-P96)
Source: H00-H59 (chapter, inherited).
Excludes2
certain infectious and parasitic diseases (A00-B99)
Source: H00-H59 (chapter, inherited).
Excludes2
complications of pregnancy, childbirth and the puerperium (O00-O9A)
Source: H00-H59 (chapter, inherited).
Excludes2
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
Source: H00-H59 (chapter, inherited).
Excludes2
diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)
Source: H00-H59 (chapter, inherited).
Excludes2
endocrine, nutritional and metabolic diseases (E00-E88)
Source: H00-H59 (chapter, inherited).
Excludes2
injury (trauma) of eye and orbit (S05.-)
Source: H00-H59 (chapter, inherited).
Excludes2
injury, poisoning and certain other consequences of external causes (S00-T88)
Source: H00-H59 (chapter, inherited).
Excludes2
neoplasms (C00-D49)
Source: H00-H59 (chapter, inherited).
Excludes2
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Source: H00-H59 (chapter, inherited).
Excludes2
syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)
Source: H00-H59 (chapter, inherited).
Code first
underlying disease, such as:
Source: H36 (category, inherited).
Code first
lipid storage disorders (E75.-)
Source: H36 (category, inherited).
Code first
sickle-cell disorders (D57.-)
Source: H36 (category, inherited).
Excludes1
arteriosclerotic retinopathy (H35.0-)
Source: H36 (category, inherited).
Excludes1
diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)
Source: H36 (category, inherited).
Compare the FY2027 additions, removals and billable-status changes
What does H36.813 mean in FY2027?
The official ICD-10-CM descriptor is Nonproliferative sickle-cell retinopathy, bilateral. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Is H36.813 billable in FY2027?
The FY2027 order file marks H36.813 as billable. Check the complete Tabular instructions and documentation before assigning it.
Does H36.813 map to an HCC?
In the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service), H36.813 maps to CMS-HCC V28 HCC 108 (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major). For 2027 dates of service, CMS has not yet published the payment year 2028 mappings. ESRD, RxHCC, PACE and HHS-HCC mappings are still pending verification for FY2027.
Source: CMS FY2027 ICD-10-CM order file. Read the FY2027 Official Guidelines.
Review the FY2026 April edition