Q13.1 ICD-10-CM Code: Absence of iris
HCC Buddy Code Card
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FY 2026 Apr update / Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0) / Congenital malformations of eye, ear, face and neck (Q10-Q18)
Q13.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAbsence of iris
A rare congenital condition where a person is born without an iris, the colored part of the eye that controls pupil size and light entry.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Aniridia
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Q13.1 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Q13.1 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for Q13.1 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Q13.1 in this effective period.
Use Additional
Official- code for associated glaucoma (H42)
Code Also
OfficialICD-10-CM does not list Code Also instructions for Q13.1 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is Q13.1 an HCC code?
No. Q13.1 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- Q13.1
- Description
- Absence of iris
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
Q13.1 is the ICD-10-CM diagnosis code for absence of iris. A rare congenital condition where a person is born without an iris, the colored part of the eye that controls pupil size and light entry. Q13.1 sits in the ICD-10-CM chapter for congenital malformations, deformations and chromosomal abnormalities (q00-qa0), within the section covering congenital malformations of eye, ear, face and neck (q10-q18).
Q13.1 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.
This is a severe condition; ensure documentation specifies complete absence versus partial absence.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q13.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a severe condition; ensure documentation specifies complete absence versus partial absence
- •Verify laterality and document any associated vision impairment or light sensitivity
Use Additional Code
- code for associated glaucoma (H42)