H59.363 ICD-10-CM Code: Postprocedural seroma of eye and adnexa following other procedure, bilateral
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified (H59)
H59.363
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePostprocedural seroma of eye and adnexa following other procedure, bilateral
A fluid collection (seroma) that develops after eye surgery or other medical procedures, occurring in both eyes. This is a complication where fluid accumulates in the surgical area rather than being reabsorbed normally.
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
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Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H59.363 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H59.363 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H59.363 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H59.363 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H59.363 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H59.363 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H59.363 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 H59.363 an HCC code?
No. H59.363 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
H59.363 is the ICD-10-CM diagnosis code for postprocedural seroma of eye and adnexa following other procedure, bilateral. A fluid collection (seroma) that develops after eye surgery or other medical procedures, occurring in both eyes. This is a complication where fluid accumulates in the surgical area rather than being reabsorbed normally. H59.363 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified (h59).
H59.363 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 the procedure that caused the seroma is documented and that it was NOT an ophthalmologic procedure (if it was an eye procedure, use H59.35- instead).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H59.363 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the procedure that caused the seroma is documented and that it was NOT an ophthalmologic procedure (if it was an eye procedure, use H59.35- instead)
- •Confirm bilateral involvement is documented in the medical record before assigning this code; if only one eye is affected, use the unilateral code H59.361 or H59.362