H36.823 ICD-10-CM Code: Proliferative sickle-cell retinopathy, bilateral
H36.823 maps to CMS-HCC V28 HCCs 108 and 298. Source-labeled RAF references are available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)
H36.823
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceProliferative sickle-cell retinopathy, bilateral
Abnormal new blood vessel growth in the back of both eyes due to sickle cell disease, representing advanced retinopathy affecting both sides.
Buddy Insight
Proliferative sickle-cell retinopathy, bilateral indicates advanced sickle cell retinal disease with neovascularization in both eyes, representing the most severe retinal manifestation of sickle cell disease.
CMS-HCC V28
MappedHCC 108
Coefficient HCC 108: 0.146 (Community Non-Dual Aged (CNA)); HCC 298: 0.336 (Community Non-Dual Aged (CNA))
+ HCC 298
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 071
Code-level coefficient reference
ESRD/PACE
MappedHCC 46
Code-level coefficient reference
+ HCC 122
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for H36.823. 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 H36.823. Check the code and parent instructions in the Code Book.
Excludes 1
Official- arteriosclerotic retinopathy (H35.0-)Inherited from H36
- diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H36
Code First
Official- underlying disease, such as:Inherited from H36
- lipid storage disorders (E75.-)Inherited from H36
- sickle-cell disorders (D57.-)Inherited from H36
Use Additional
OfficialNo Use Additional Code instructions are included in this display for H36.823. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for H36.823. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 →
Is H36.823 an HCC code?
Yes. H36.823 (Proliferative sickle-cell retinopathy, bilateral) maps to HCC 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major and HCC 298, Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage under the CMS-HCC V28 risk adjustment model, with source-labeled community non-dual aged reference coefficients HCC 108 0.146 and HCC 298 0.336. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: H36.823 is billable and maps to V28 HCC 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major and HCC 298, Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- H36.823
- Description
- Proliferative sickle-cell retinopathy, bilateral
- HCC (V28)
- HCC 108 — Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major; HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage
- RAF reference coefficient
- HCC 108: 0.146; HCC 298: 0.336
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work H36.823 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for H36.823
For H36.823, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
Get the V28 mapping + MEAT cheat sheet
One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
H36.823 is the ICD-10-CM diagnosis code for proliferative sickle-cell retinopathy, bilateral. Abnormal new blood vessel growth in the back of both eyes due to sickle cell disease, representing advanced retinopathy affecting both sides. H36.823 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).
Under the CMS-HCC V28 risk adjustment model, H36.823 maps to Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major (HCC 108) with a source-labeled community, non-dual, aged reference coefficient of 0.146. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Bilateral specification requires documentation confirming both eyes have proliferative changes. For H36.823, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H36.823 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Bilateral specification requires documentation confirming both eyes have proliferative changes
- •This advanced form warrants close ophthalmologic monitoring and may require intervention
Clinical Significance
Proliferative sickle-cell retinopathy, bilateral indicates advanced sickle cell retinal disease with neovascularization in both eyes, representing the most severe retinal manifestation of sickle cell disease. Bilateral proliferative disease carries a significant risk of bilateral vision loss and reflects severe underlying systemic disease. These patients require aggressive bilateral retinal management and close systemic monitoring.
Documentation Requirements
- ✓Bilateral dilated fundoscopic examination documenting neovascularization in both eyes
- ✓Individual staging (Goldberg classification) for each eye
- ✓Fluorescein angiography of both eyes documenting areas of nonperfusion and neovascularization
- ✓Documentation of sickle cell disease type and systemic disease severity
- ✓Bilateral treatment plan and coordination with hematology
Commonly Confused Codes
- •H36.813: Nonproliferative sickle-cell retinopathy, bilateral: earlier stage without neovascularization in either eye
- •H36.821/H36.822: Proliferative sickle-cell retinopathy, right/left eye: use when only one eye has proliferative disease
- •H36.829: Proliferative sickle-cell retinopathy, unspecified eye: less specific, use only when laterality unknown
- •E11.3593: Type 2 diabetes with proliferative diabetic retinopathy, bilateral: diabetic etiology, not sickle cell