Question 1

What is ICD-10 code H60.313?

Accepted Answer

H60.313 is the ICD-10-CM diagnosis code for diffuse otitis externa, bilateral. A widespread inflammation of the entire ear canal affecting both ears, typically caused by bacterial infection and characterized by itching, pain, and drainage. H60.313 sits in the ICD-10-CM chapter for diseases of the ear and mastoid process (h60-h95), within the section covering diseases of external ear (h60-h62).

H60.313 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.

Bilateral diffuse otitis externa may suggest a systemic or environmental cause; review clinical context.

Question 2

Is H60.313 an HCC code?

Accepted Answer

No. H60.313 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 H60.313 billable?

Accepted Answer

Yes. H60.313 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. H60.313 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 H60.313?

Accepted Answer

H60.313 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 H60.313 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 H60.313?

Accepted Answer

Bilateral diffuse otitis externa may suggest a systemic or environmental cause; review clinical context Ensure documentation explicitly confirms bilateral involvement before assigning this code

HCC Buddy Code Card

H60.313

Is H60.313 an HCC code?

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Open H60.313 in the Interactive Encoder

H60.313 ICD-10-CM Code: Diffuse otitis externa, bilateral

HCC Buddy Code Card

H60.313

Is H60.313 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H60.313 in the Interactive Encoder