H43.12 ICD-10-CM Code: Vitreous hemorrhage, left eye
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of vitreous body and globe (H43-H44)
H43.12
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceVitreous hemorrhage, left eye
Bleeding inside the clear gel of the left eye, which can cause sudden vision loss or floaters.
Buddy Insight
Vitreous hemorrhage represents bleeding into the vitreous cavity of the eye, which can significantly impair vision and may indicate serious underlying conditions such as proliferative diabetic retinopathy, retinal tear or detachment, or posterior vitreous detachment.
CMS-HCC V28
MappedHCC 298
RAF 0.209
CMS-HCC V24
MappedHCC 122
RAF 0.209
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 122
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H43.12 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H43.12 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H43.12 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H43.12 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H43.12 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H43.12 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H43.12 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H43.12 an HCC code?
Yes. H43.12 maps to Proliferative Diabetic Retinopathy and Vitreous Hemorrhage under the CMS-HCC V28 risk adjustment model (and Proliferative Diabetic Retinopathy and Vitreous Hemorrhage under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for H43.12
For H43.12to 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 H43.12 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
H43.12 is the ICD-10-CM diagnosis code for vitreous hemorrhage, left eye. Bleeding inside the clear gel of the left eye, which can cause sudden vision loss or floaters. H43.12 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of vitreous body and globe (h43-h44).
Under the CMS-HCC V28 risk adjustment model, H43.12 maps to Proliferative Diabetic Retinopathy and Vitreous Hemorrhage (HCC 298) with a community, non-dual, aged base RAF weight of 0.209. The V24 model used during the PY2024–PY2025 transition mapped H43.12 the same way and at the same RAF weight. 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.
Confirm left eye documentation; do not use if condition affects both eyes. Because H43.12 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for H43.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm left eye documentation; do not use if condition affects both eyes
- •Often associated with retinal breaks or vascular disease; document underlying etiology separately
Clinical Significance
Vitreous hemorrhage represents bleeding into the vitreous cavity of the eye, which can significantly impair vision and may indicate serious underlying conditions such as proliferative diabetic retinopathy, retinal tear or detachment, or posterior vitreous detachment. This diagnosis carries notable risk adjustment weight, reflecting the clinical complexity and resource utilization associated with evaluation and management.
Documentation Requirements
- ✓Laterality clearly specified as left eye
- ✓Clinical documentation of vitreous hemorrhage confirmed by dilated fundus examination or B-scan ultrasonography
- ✓Documented underlying etiology when identified (diabetic retinopathy, retinal tear, trauma, etc.)
- ✓Visual acuity assessment
- ✓Duration and onset of symptoms (acute vs. chronic/recurrent)
- ✓Treatment plan (observation, intravitreal injection, vitrectomy, laser treatment)
- ✓If diabetic, document the relationship to diabetic retinopathy with appropriate combination code
Commonly Confused Codes
- •H35.60-H35.63: Retinal hemorrhage (bleeding within or on the retinal surface, not in the vitreous cavity)
- •H44.811-H44.819: Hemophthalmos (blood in the anterior chamber, not vitreous; though terminology overlaps)
- •H31.301-H31.309: Choroidal hemorrhage (bleeding in the choroid, not vitreous)
- •E11.3511-E11.3593: Type 2 diabetes with proliferative diabetic retinopathy with vitreous hemorrhage (use combination code when diabetes is the cause)
- •H43.311-H43.313: Vitreous membranes and strands (sequela of old hemorrhage, not active bleeding)