H36.822
BillableProliferative sickle-cell retinopathy, left eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H36.822 an HCC code?
No. H36.822 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H36.822 is the ICD-10-CM diagnosis code for proliferative sickle-cell retinopathy, left eye. Abnormal new blood vessel growth in the back of the left eye due to sickle cell disease, representing advanced retinopathy. H36.822 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).
H36.822 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.
H36.822 does not map to any HCC in V28, V24, ESRD, or RxHCC models. Despite being the more advanced and sight-threatening form of sickle cell retinopathy, it lacks HCC mapping. Risk adjustment for sickle cell patients relies on the underlying hemoglobinopathy codes. This is a notable gap in the current HCC mapping system.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H36.822 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify left eye is specifically documented to differentiate from right eye or bilateral codes
- •Proliferative sickle-cell retinopathy carries higher risk for vision loss than nonproliferative forms
Clinical Significance
Proliferative sickle-cell retinopathy of the left eye indicates advanced sickle cell retinal disease with neovascularization in the left eye. The clinical significance, treatment approach, and potential complications are identical to right eye involvement. Left eye involvement may occur independently or concurrently with right eye disease, and each eye requires individual assessment and treatment planning.
Documentation Requirements
- ✓Detailed fundoscopic examination of the left eye documenting neovascularization and its extent
- ✓Fluorescein angiography findings for the left eye when performed
- ✓Goldberg staging classification for the left eye
- ✓Documentation of underlying sickle cell genotype
- ✓Treatment plan specific to the left eye findings
Commonly Confused Codes
- •H36.812 — Nonproliferative sickle-cell retinopathy, left eye: earlier stage without neovascularization
- •H36.821 — Proliferative sickle-cell retinopathy, right eye: same stage, contralateral side
- •H36.823 — Proliferative sickle-cell retinopathy, bilateral: use when both eyes have proliferative disease
- •H35.029 — Exudative retinopathy, unspecified eye: different pathology