Question 1

What is ICD-10 code H61.112?

Accepted Answer

H61.112 is the ICD-10-CM diagnosis code for acquired deformity of pinna, left ear. A permanent change in the shape or structure of the left outer ear (pinna) that developed after birth, often from injury or disease. H61.112 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).

H61.112 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.

Document the cause of deformity when possible (trauma, surgery, disease) to support medical necessity.

Question 2

Is H61.112 an HCC code?

Accepted Answer

No. H61.112 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 H61.112 billable?

Accepted Answer

Yes. H61.112 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. H61.112 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 H61.112?

Accepted Answer

H61.112 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 H61.112 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 H61.112?

Accepted Answer

Document the cause of deformity when possible (trauma, surgery, disease) to support medical necessity Distinguish from congenital deformities, which use different ICD-10 codes in the Q18 range

HCC Buddy Code Card

H61.112

Is H61.112 an HCC code?

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Code Hierarchy

Open H61.112 in the Interactive Encoder

H61.112 ICD-10-CM Code: Acquired deformity of pinna, left ear

HCC Buddy Code Card

H61.112

Is H61.112 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H61.112 in the Interactive Encoder