Question 1

What is ICD-10 code H47.631?

Accepted Answer

H47.631 is the ICD-10-CM diagnosis code for disorders of visual cortex in (due to) neoplasm, right side of brain. Problems with the visual cortex on the right side of the brain caused by a tumor or cancer affecting the visual processing area. H47.631 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of optic nerve and visual pathways (h46-h47).

H47.631 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.

Code the specific neoplasm separately using appropriate neoplasm codes from Chapter 2.

Question 2

Is H47.631 an HCC code?

Accepted Answer

No. H47.631 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H47.631 billable?

Accepted Answer

Yes. H47.631 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. H47.631 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for H47.631?

Accepted Answer

H47.631 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards H47.631 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting H47.631?

Accepted Answer

Code the specific neoplasm separately using appropriate neoplasm codes from Chapter 2 Confirm right-sided location is documented in the imaging or clinical notes

HCC Buddy Code Card

H47.631

Is H47.631 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H47.631 in the Interactive Encoder

H47.631 ICD-10-CM Code: Disorders of visual cortex in (due to) neoplasm, right side of brain

HCC Buddy Code Card

H47.631

Is H47.631 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H47.631 in the Interactive Encoder