H36.829
BillableProliferative sickle-cell retinopathy, unspecified eye
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is H36.829 an HCC code?
No. H36.829 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
H36.829 is the ICD-10-CM diagnosis code for proliferative sickle-cell retinopathy, unspecified eye. Abnormal new blood vessel growth in the back of the eye due to sickle cell disease when the specific eye is not documented. H36.829 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).
H36.829 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.
H36.829 does not map to any HCC in V28, V24, ESRD, or RxHCC models. Like the laterality-specific proliferative codes, this lacks HCC mapping. Risk adjustment for sickle cell patients depends on the underlying hemoglobinopathy codes rather than the retinal complication codes.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H36.829 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when laterality is truly unspecified in the medical record
- •Query provider for eye-specific documentation to allow more precise coding when possible
Clinical Significance
Proliferative sickle-cell retinopathy, unspecified eye is used when proliferative sickle cell retinal disease is documented but the laterality is not specified. This code should rarely be necessary in clinical practice since ophthalmologic examinations routinely document laterality. It represents a documentation improvement opportunity to capture the specific eye(s) involved.
Documentation Requirements
- ✓Documentation of proliferative sickle-cell retinopathy without laterality specification
- ✓Confirmation of neovascularization on fundoscopic examination
- ✓Underlying sickle cell disease documentation
- ✓Query to ophthalmologist for laterality clarification
- ✓Treatment and surveillance plan