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H43.813 ICD-10-CM Code: Vitreous degeneration, bilateral

H43.813 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupH43.813

FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of vitreous body and globe (H43-H44)

H43.813

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

Vitreous degeneration, bilateral

Deterioration or breakdown of the clear gel (vitreous) that fills both eyes. This can cause floaters or blurred vision in both eyes.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

N/A

—

Not mapped

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

N/A

—

Not mapped

ESRD/PACE

N/A

—

Not mapped

RXHCC

N/A

—

Not mapped

Code Book Path

Official
H43.8Other disorders of vitreous bodyH43.81Vitreous degenerationH43.813Vitreous degeneration, bilateral

Inclusion Terms

Official
  • Vitreous detachmentInherited from H43.81

Excludes 2

Official
  • certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59, H43.8
  • certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59, H43.8
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59, H43.8
  • congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59, H43.8
  • diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59, H43.8
  • endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59, H43.8
  • injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59, H43.8
  • injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59, H43.8
  • neoplasms (C00-D49)Inherited from H00-H59, H43.8
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59, H43.8
  • syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59, H43.8
  • vitreous abscess (H44.02-)Inherited from H00-H59, H43.8

Related Codes

Official
H43.811Vitreous degeneration, right eyeH43.812Vitreous degeneration, left eyeH43.819Vitreous degeneration, unspecified eye

Includes

Official

No Includes notes are included in this display for H43.813. Check the code and parent instructions in the Code Book.

Excludes 1

Official
  • proliferative vitreo-retinopathy with retinal detachment (H33.4-)Inherited from H43.8

Code First

Official

No Code First sequencing instructions are included in this display for H43.813. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for H43.813. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for H43.813. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Use this code only when documentation clearly indicates bilateral involvement
Report this code once per encounter; do not report separately for each eye

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 H43.813 an HCC code?

No. H43.813 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code
H43.813
Description
Vitreous degeneration, bilateral
HCC (V28)
No CMS-HCC V28 mapping
RAF reference coefficient
—
Billable
Yes
Payment year
2026

Coder workflow notes

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What This Code Means

H43.813 is the ICD-10-CM diagnosis code for vitreous degeneration, bilateral. Deterioration or breakdown of the clear gel (vitreous) that fills both eyes. This can cause floaters or blurred vision in both eyes. H43.813 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).

H43.813 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Use this code only when documentation clearly indicates bilateral involvement.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H43.813 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Use this code only when documentation clearly indicates bilateral involvement
  • •Report this code once per encounter; do not report separately for each eye

Child Codes

H43.811Vitreous degeneration, right eye
H43.812Vitreous degeneration, left eye
H43.813Vitreous degeneration, bilateral
H43.819Vitreous degeneration, unspecified eye

Code Hierarchy

└H43Disorders of vitreous body└H43.8Other disorders of vitreous body└H43.81Vitreous degeneration└H43.813Vitreous degeneration, bilateral
└H43.813Vitreous degeneration, bilateral

Also searched as

  • H43 813
  • H43813

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