Question 1

What is ICD-10 code H61.313?

Accepted Answer

H61.313 is the ICD-10-CM diagnosis code for acquired stenosis of external ear canal secondary to trauma, bilateral. Narrowing of both ear canals that resulted from previous injuries or trauma to both ears. H61.313 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).

H61.313 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.

Use only when trauma affected both ears.

Question 2

Is H61.313 an HCC code?

Accepted Answer

No. H61.313 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 H61.313 billable?

Accepted Answer

Yes. H61.313 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. H61.313 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 H61.313?

Accepted Answer

H61.313 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 H61.313 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 H61.313?

Accepted Answer

Use only when trauma affected both ears Document whether trauma occurred simultaneously or at different times

HCC Buddy Code Card

H61.313

Is H61.313 an HCC code?

What This Code Means

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Open H61.313 in the Interactive Encoder

H61.313 ICD-10-CM Code: Acquired stenosis of external ear canal secondary to trauma, bilateral

HCC Buddy Code Card

H61.313

Is H61.313 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H61.313 in the Interactive Encoder