Skip to main content

H26.211 ICD-10-CM Code: Cataract with neovascularization, right eye

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 Excludes1 · 2 code-also instructions

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 124 — OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT (MDC 02)
  • MS-DRG 125 — OTHER DISORDERS OF THE EYE WITHOUT MCC (MDC 02)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for H26.211 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on H26.211 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from H26

Code Also

Additional codes that may be required to fully describe the encounter.

  • Code also, if applicable, associated condition, such as:
  • chronic iridocyclitis (H20.1-)

Source: inherited from H26.21

Coder workflow for H26.211

MedCoder structured workflow — derived from this code’s own official record

Before you code H26.211

  1. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: right). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

    ReviewH26.212 · left, H26.213 · bilateral, H26.219 · unspecified

    Guide: Laterality coding →

  2. H26.211’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with H26.211. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in H26.211’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewQ12.0

  2. Is the side documented?
    Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
    No → Use the unspecified-side code only when the record states no side; a query is the alternative.

    ReviewH26.212 · left, H26.213 · bilateral, H26.219 · unspecified

Consider H26.211. Then review the Code Also note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Laterality
Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).

Official instructions as workflow

  • Excludes1 — check before selecting H26.211(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with H26.211: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareQ12.0

    See the official tabular notes · Guidelines I.A.12.a

  • Code Also — related condition(2 notes)

    Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

    ReviewH20.1

    See the official tabular notes · Guidelines I.A.17

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition H26.211 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewQ12.0

Documentation: The record documents the condition on one side only.

Coding question: Which code in this family applies?

Path: Select the sibling code for the documented side.

Reason: Laterality is assigned from the documented side; the unspecified-side code is for records that state no side (Guidelines I.B.13).

ReviewH26.212 · left, H26.213 · bilateral, H26.219 · unspecified

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is H26.211 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Cataract with neovascularization, right eye is a billable ICD-10-CM diagnosis code (H26.211).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
  2. 2 Code Also notes — a second code may apply; the guidelines leave its sequencing to the circumstances of the encounter. See the Code Also notes
  3. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name H26.211 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Use Additional Code instruction: H20.1 — Chronic iridocyclitis (via H26.21.-).

These codes instruct coders to additionally report this code when it applies.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 2 MS-DRGs: DRG 124 (MDC 02), DRG 125 (MDC 02).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):EYE002 — Cataract and other lens disorders (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same condition, opposite side

Same category and title, differing only in which side of the body is affected.

H26.212 — Cataract with neovascularization, left eye (left)Compare H26.211 vs H26.212 →, H26.213 — Cataract with neovascularization, bilateral (bilateral)Compare H26.211 vs H26.213 →, H26.219 — Cataract with neovascularization, unspecified eye (unspecified)Compare H26.211 vs H26.219 →

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Cataract and other lens disorders).

H26.119 — Localized traumatic opacities, unspecified eye, H26.121 — Partially resolved traumatic cataract, right eye, H26.122 — Partially resolved traumatic cataract, left eye, H26.123 — Partially resolved traumatic cataract, bilateral, H26.129 — Partially resolved traumatic cataract, unspecified eye, H26.131 — Total traumatic cataract, right eye, H26.132 — Total traumatic cataract, left eye, H26.133 — Total traumatic cataract, bilateral, H26.139 — Total traumatic cataract, unspecified eye, H26.20 — Unspecified complicated cataract, H26.212 — Cataract with neovascularization, left eye, H26.213 — Cataract with neovascularization, bilateral, H26.219 — Cataract with neovascularization, unspecified eye, H26.221 — Cataract secondary to ocular disorders (degenerative) (inflammatory), right eye, H26.222 — Cataract secondary to ocular disorders (degenerative) (inflammatory), left eye, H26.223 — Cataract secondary to ocular disorders (degenerative) (inflammatory), bilateral, H26.229 — Cataract secondary to ocular disorders (degenerative) (inflammatory), unspecified eye, H26.231 — Glaucomatous flecks (subcapsular), right eye, H26.232 — Glaucomatous flecks (subcapsular), left eye, H26.233 — Glaucomatous flecks (subcapsular), bilateral, +103 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Cataract”; these codes share that main term but sit in a different category of the Tabular List.

E03.9 — Hypothyroidism, unspecified (myxedema), E20.9 — Hypoparathyroidism, unspecified (in, hypoparathyroidism), E34.9 — Endocrine disorder, unspecified (in, endocrine disease), E46 — Unspecified protein-calorie malnutrition (malnutrition-dehydration), E63.9 — Nutritional deficiency, unspecified (in, nutritional disease), E74.21 — Galactosemia (associated with, galactosemia), E88.9 — Metabolic disorder, unspecified (in, metabolic disease), G71.19 — Other specified myotonic disorders (myotonic), H25.01 — Cortical age-related cataract (senile, cortical), H25.03 — Anterior subcapsular polar age-related cataract (senile, subcapsular polar), H25.04 — Posterior subcapsular polar age-related cataract (senile, subcapsular polar, posterior), H25.09 — Other age-related incipient cataract (senile, incipient), H25.1 — Age-related nuclear cataract (senile, nuclear), H25.2 — Age-related cataract, morgagnian type (senile, morgagnian type), H25.81 — Combined forms of age-related cataract (senile, combined forms), H25.89 — Other age-related cataract (senile, specified NEC), H25.9 — Unspecified age-related cataract (senile), Q12.0 — Congenital cataract (blue), Z98.4 — Cataract extraction status (extraction status)

Contextual Map

Every relationship of H26.211 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run H26.211 with this related code in Claim Check

Hierarchy

Referenced by Use Additional Code instructions

  • H20.1 — Chronic iridocyclitis[Use Additional Code](via H26.21.-): “code for any associated cataract (H26.21-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 02 — Diseases and Disorders of the Eye[MDC crossing]: “Diseases and Disorders of the Eye — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,200 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "H26.211 — Cataract with neovascularization, right eye." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/h26.211-cataract-with-neovascularization-right-eye

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Cataract with neovascularization, right eye

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to H26.211 in its code family, with their registry titles.

View all codes in the H26 family