Question 1

What is ICD-10 code R94.111?

Accepted Answer

R94.111 is the ICD-10-CM diagnosis code for abnormal electroretinogram [erg]. An ERG (retinal function test) shows abnormal electrical response of the retina to light stimulation. R94.111 sits in the ICD-10-CM chapter for symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (r00-r99), within the section covering abnormal findings on diagnostic imaging and in function studies, without diagnosis (r90-r94).

R94.111 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.

ERG measures how well the retina responds to light; specify if the abnormality is generalized or localized.

Question 2

Is R94.111 an HCC code?

Accepted Answer

No. R94.111 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 R94.111 billable?

Accepted Answer

Yes. R94.111 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. R94.111 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 R94.111?

Accepted Answer

R94.111 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 R94.111 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 R94.111?

Accepted Answer

ERG measures how well the retina responds to light; specify if the abnormality is generalized or localized This test helps diagnose retinal diseases such as retinitis pigmentosa or other photoreceptor disorders

R94.111

Is R94.111 an HCC code?

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Open R94.111 in the Interactive Encoder