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H36.829 ICD-10-CM Code: Proliferative sickle-cell retinopathy, unspecified eye

H36.829 maps to CMS-HCC V28 HCCs 108 and 298. Source-labeled RAF references are available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of choroid and retina (H30-H36)

H36.829

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

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.

Buddy the Bee presenting code insight

Buddy Insight

Proliferative sickle-cell retinopathy, unspecified eye is used when proliferative sickle cell retinal disease is documented but the laterality is not specified.

CMS-HCC V28

HCC 108

Code-level coefficient reference

+ HCC 298

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 071

Code-level coefficient reference

ESRD/PACE

HCC 46

Code-level coefficient reference

+ HCC 122

RXHCC

N/A

—

Not mapped

Code Book Path

Official
H36.8Other retinal disorders in diseases classified elsewhere
H36.82Proliferative sickle-cell retinopathy
H36.829Proliferative sickle-cell retinopathy, unspecified eye

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for H36.829 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for H36.829 in this effective period.

Related Child Codes

Official
H36.821Proliferative sickle-cell retinopathy, right eye
H36.822Proliferative sickle-cell retinopathy, left eye
H36.823Proliferative sickle-cell retinopathy, bilateral

Includes

Official

ICD-10-CM does not list Includes notes for H36.829 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for H36.829 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for H36.829 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for H36.829 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for H36.829 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
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

MEAT Support

HCC Buddy guidance
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

Audit Caution

HCC Buddy guidance
Using this code when laterality information is available in the ophthalmology record
Confusing with nonproliferative form — proliferative requires documented neovascularization
Not querying the provider for laterality specification
Using retinal disorder codes that do not capture the sickle cell etiology

Common Mistakes

HCC Buddy guidance
H36.821-H36.823 — Laterality-specific proliferative sickle-cell retinopathy: always preferred when laterality is documented
H36.819 — Nonproliferative sickle-cell retinopathy, unspecified eye: earlier stage without neovascularization
H35.9 — Unspecified retinal disorder: overly nonspecific
D57.819 — Other sickle-cell disorders with unspecified crisis: underlying condition, not retinal manifestation

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 H36.829 an HCC code?

Yes. H36.829 (Proliferative sickle-cell retinopathy, unspecified eye) 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: H36.829 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
H36.829
Description
Proliferative sickle-cell retinopathy, unspecified eye
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

V28HCC 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
0.146
+ HCC 298, Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage0.336
ESRDHCC 46, Severe Hematological Disorders
Not separately weighted
+ HCC 122, Proliferative Diabetic Retinopathy and Vitreous HemorrhageNot separately weighted

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 H36.829 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for H36.829

For H36.829 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

  • 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

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed H36.829 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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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).

Under the CMS-HCC V28 risk adjustment model, H36.829 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. No V24 mapping is shown for H36.829; use the applicable model and payment year when reviewing the V28 mapping. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. 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.

Use only when laterality is truly unspecified in the medical record. Because H36.829 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 H36.829 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

Commonly Confused Codes

  • •H36.821-H36.823: Laterality-specific proliferative sickle-cell retinopathy: always preferred when laterality is documented
  • •H36.819: Nonproliferative sickle-cell retinopathy, unspecified eye: earlier stage without neovascularization
  • •H35.9: Unspecified retinal disorder: overly nonspecific
  • •D57.819: Other sickle-cell disorders with unspecified crisis: underlying condition, not retinal manifestation

Child Codes

H36.821Proliferative sickle-cell retinopathy, right eye
HCC 108
H36.822Proliferative sickle-cell retinopathy, left eye
HCC 108
H36.823Proliferative sickle-cell retinopathy, bilateral
HCC 108
H36.829Proliferative sickle-cell retinopathy, unspecified eye
HCC 108

Code Hierarchy

└H36Retinal disorders in diseases classified elsewhere└H36.8Other retinal disorders in diseases classified elsewhere└H36.82Proliferative sickle-cell retinopathy└H36.829Proliferative sickle-cell retinopathy, unspecified eye
└H36.829Proliferative sickle-cell retinopathy, unspecified eye

H36.829 code history

Code setChange
FY2024 (effective Oct 1, 2023)Added to the code set

Source: official CMS ICD-10-CM order and addenda files, FY2016 through FY2027.

Because H36.829 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment.

H36.829 maps to CMS-HCC V28 category 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major and CMS-HCC V28 category 298, Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies payment HCC categories for H36.829. Review their source-labeled HCC coefficients above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

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