H53.413 ICD-10-CM Code: Scotoma involving central area, bilateral
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Visual disturbances and blindness (H53-H54)
H53.413
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceScotoma involving central area, bilateral
A scotoma is a blind spot or area of vision loss in the central part of the visual field that affects both eyes. This condition means the patient has difficulty seeing objects directly in front of them in both eyes.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Central scotoma
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H53.413 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H53.413 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H53.413 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H53.413 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H53.413 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H53.413 in this effective period.
Buddy Documentation Tip
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 H53.413 an HCC code?
No. H53.413 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
H53.413 is the ICD-10-CM diagnosis code for scotoma involving central area, bilateral. A scotoma is a blind spot or area of vision loss in the central part of the visual field that affects both eyes. This condition means the patient has difficulty seeing objects directly in front of them in both eyes. H53.413 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering visual disturbances and blindness (h53-h54).
H53.413 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.
Verify documentation specifies 'bilateral' (both eyes) before assigning this code; if only one eye is affected, use H53.411 (right eye) or H53.412 (left eye) instead.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H53.413 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies 'bilateral' (both eyes) before assigning this code; if only one eye is affected, use H53.411 (right eye) or H53.412 (left eye) instead
- •Investigate the underlying cause of the scotoma (such as macular degeneration, diabetic retinopathy, or optic nerve disease) and code the etiology separately if documented