Q13.4 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupQ13.4

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0) / Congenital malformations of eye, ear, face and neck (Q10-Q18)

Q13.4

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other congenital corneal malformations

Various other birth defects of the cornea not classified elsewhere, such as corneal flattening, steepening, or other structural abnormalities.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

Q13Congenital malformations of anterior segment of eye Q13.4Other congenital corneal malformations

Inclusion Terms

Official

Congenital malformation of cornea NOS
Microcornea
Peter's anomaly

Excludes 2

Official

inborn errors of metabolism (E70-E88)Inherited from Q00-QA0, Q10-Q18
cleft lip and cleft palate (Q35-Q37)Inherited from Q00-QA0, Q10-Q18
congenital malformation of cervical spine (Q05.0, Q05.5, Q67.5, Q76.0-Q76.4)Inherited from Q00-QA0, Q10-Q18
congenital malformation of larynx (Q31.-)Inherited from Q00-QA0, Q10-Q18
congenital malformation of lip NEC (Q38.0)Inherited from Q00-QA0, Q10-Q18
congenital malformation of nose (Q30.-)Inherited from Q00-QA0, Q10-Q18
congenital malformation of parathyroid gland (Q89.2)Inherited from Q00-QA0, Q10-Q18
congenital malformation of thyroid gland (Q89.2)Inherited from Q00-QA0, Q10-Q18

Related Codes

Official

Q13.0Coloboma of iris Q13.1Absence of iris Q13.2Other congenital malformations of iris Q13.3Congenital corneal opacity Q13.5Blue sclera

Includes

Official

No Includes notes are included in this display for Q13.4. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for Q13.4. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for Q13.4. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for Q13.4. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for Q13.4. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Use this code for corneal malformations that don't fit the opacity category

Document specific corneal measurements or findings (keratometry readings) when available

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 Q13.4 an HCC code?

No. Q13.4 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: Q13.4
Description: Other congenital corneal malformations
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

Q13.4 is the ICD-10-CM diagnosis code for other congenital corneal malformations. Various other birth defects of the cornea not classified elsewhere, such as corneal flattening, steepening, or other structural abnormalities. Q13.4 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).

Q13.4 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Use this code for corneal malformations that don't fit the opacity category.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for Q13.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code for corneal malformations that don't fit the opacity category
•Document specific corneal measurements or findings (keratometry readings) when available