Question 1

What is ICD-10 code Z83.511?

Accepted Answer

Z83.511 is the ICD-10-CM diagnosis code for family history of glaucoma. A family member has glaucoma, an eye disease characterized by increased pressure that can lead to vision loss. Z83.511 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons with potential health hazards related to family and personal history and certain conditions influencing health status (z77-z99).

Z83.511 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 this when a patient reports family history of glaucoma to identify increased risk for screening.

Question 2

Is Z83.511 an HCC code?

Accepted Answer

No. Z83.511 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 Z83.511 billable?

Accepted Answer

Yes. Z83.511 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. Z83.511 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 Z83.511?

Accepted Answer

Z83.511 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 Z83.511 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 Z83.511?

Accepted Answer

Document this when a patient reports family history of glaucoma to identify increased risk for screening This code is specifically for glaucoma; use Z83.518 for other eye disorders

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Z83.511

Is Z83.511 an HCC code?

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Z83.511 ICD-10-CM Code: Family history of glaucoma

HCC Buddy Code Card

Z83.511

Is Z83.511 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open Z83.511 in the Interactive Encoder