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H36.822 ICD-10-CM Code: Proliferative sickle-cell retinopathy, left eye

Compare with another code for H36.822Check this code on a claim

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

Coding at a Glance

Tabular directives
2 Excludes1 · 3 code-first instructions
Risk adjustment
CMS-HCC V28: 2 categories · CMS-HCC V22 category 122 · CMS-HCC V22 category 46

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too, and is marked with where it comes from.

Code firstfrom H36Sequence the underlying condition before this code
  • underlying disease, such as:
  • lipid storage disorders (E75.-)
  • sickle-cell disorders (D57.-)
Excludes1from H36Not reported with this code unless documented as unrelated

Where it sits Source: CMS/NCHS

Under:Chapter 7: Diseases of the Eye and AdnexaH30-H36 Disorders of choroid and retinaH36 Retinal disorders in diseases classified elsewhereH36.8 Other retinal disorders in diseases classified elsewhereH36.82 Proliferative sickle-cell retinopathy

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

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 v44, 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.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 108 — Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
  • HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage

Other models: CMS-HCC V22 HCC 122 · CMS-HCC V22 HCC 46

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for H36.822 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on H36.822 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 H36

Code First

Underlying conditions that must be sequenced before this code.

  • underlying disease, such as:
  • lipid storage disorders (E75.-)
  • sickle-cell disorders (D57.-)

Source: inherited from H36

Coder workflow for H36.822

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

Before you code H36.822

  1. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: left). 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).

    ReviewH36.821 · right, H36.823 · bilateral, H36.829 · unspecified

    Guide: Laterality coding →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with H36.822. 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 H36.822’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.

    ReviewH35.0, E08.3, E09.3, E10.3, E11.3, E13.3

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then H36.822.
    No → Continue; do not add an underlying condition the record does not document.

    ReviewE75, D57

  3. 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.

    ReviewH36.821 · right, H36.823 · bilateral, H36.829 · unspecified

Consider H36.822. Then 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 underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).

Official instructions as workflow

  • Excludes1 — check before selecting H36.822(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with H36.822: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareH35.0, E08.3, E09.3, E10.3, E11.3, E13.3

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

  • Code First — sequencing check(3 notes)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before H36.822. Do not add an underlying condition the record does not document.

    ReviewE75, D57

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

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

Documentation: Both the condition H36.822 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).

ReviewH35.0, E08.3, E09.3, E10.3, E11.3, E13.3

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).

ReviewH36.821 · right, H36.823 · bilateral, H36.829 · unspecified

Documentation: The underlying condition the Code First note names is documented alongside this condition.

Coding question: How are the two sequenced?

Path: Review the Code First note.

Reason: The underlying condition is sequenced first and the manifestation follows (Guidelines I.A.13).

ReviewE75, D57

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.

Don’t confuse H36.822 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of H36.822 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • H35.0— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of arteriosclerotic retinopathy moves the case to H35.0; the two are not reported together unless documented as unrelated.

    Full comparison: H36.822 vs H35.0 →

  • E08.3— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of diabetic retinopathy moves the case to E08.3; the two are not reported together unless documented as unrelated.

    Full comparison: H36.822 vs E08.3 →

  • E09.3— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of diabetic retinopathy moves the case to E09.3; the two are not reported together unless documented as unrelated.

    Full comparison: H36.822 vs E09.3 →

  • E10.3— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of diabetic retinopathy moves the case to E10.3; the two are not reported together unless documented as unrelated.

    Full comparison: H36.822 vs E10.3 →

  • E11.3— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of diabetic retinopathy moves the case to E11.3; the two are not reported together unless documented as unrelated.

    Full comparison: H36.822 vs E11.3 →

  • E13.3— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of diabetic retinopathy moves the case to E13.3; the two are not reported together unless documented as unrelated.

    Full comparison: H36.822 vs E13.3 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Proliferative sickle-cell retinopathy, left eye is a billable ICD-10-CM diagnosis code (H36.822).

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. Sequencing: 3 Code First instructions — the underlying condition is sequenced before this code when present. See the Code First notes
  3. 2 Excludes1 entries — 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

  • Principal-diagnosis restriction. The Medicare Code Editor lists this code as unacceptable as a principal diagnosis: it describes a circumstance influencing health status rather than a current illness or injury being treated. It is valid as a secondary diagnosis.

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-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name H36.822 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 Excludes2 note: H35.2 — Other non-diabetic proliferative retinopathy (via H36.82.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 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):BLD005 — Sickle cell trait/anemia (default); EYE005 — Retinal and vitreous conditions.

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

Related Codes

Principal diagnosis restriction (Medicare Code Editor)

Not acceptable as a principal diagnosis on an inpatient claim.

Same condition, different side

Same title, differing only in which side of the body it names: right, left, bilateral or unspecified.

H36.821 — Proliferative sickle-cell retinopathy, right eye (right)Compare H36.822 vs H36.821 →, H36.823 — Proliferative sickle-cell retinopathy, bilateral (bilateral)Compare H36.822 vs H36.823 →, H36.829 — Proliferative sickle-cell retinopathy, unspecified eye (unspecified)Compare H36.822 vs H36.829 →

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Categories (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major, Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage) for risk-adjusted payment.

H34.8320 — Tributary (branch) retinal vein occlusion, left eye, with macular edema (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H34.8321 — Tributary (branch) retinal vein occlusion, left eye, with retinal neovascularization (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H34.8322 — Tributary (branch) retinal vein occlusion, left eye, stable (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H34.8330 — Tributary (branch) retinal vein occlusion, bilateral, with macular edema (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H34.8331 — Tributary (branch) retinal vein occlusion, bilateral, with retinal neovascularization (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H34.8332 — Tributary (branch) retinal vein occlusion, bilateral, stable (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H34.8390 — Tributary (branch) retinal vein occlusion, unspecified eye, with macular edema (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H34.8391 — Tributary (branch) retinal vein occlusion, unspecified eye, with retinal neovascularization (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H34.8392 — Tributary (branch) retinal vein occlusion, unspecified eye, stable (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H36.811 — Nonproliferative sickle-cell retinopathy, right eye (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major), H36.812 — Nonproliferative sickle-cell retinopathy, left eye (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major), H36.813 — Nonproliferative sickle-cell retinopathy, bilateral (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major), H36.819 — Nonproliferative sickle-cell retinopathy, unspecified eye (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major), H36.821 — Proliferative sickle-cell retinopathy, right eye (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H36.823 — Proliferative sickle-cell retinopathy, bilateral (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H36.829 — Proliferative sickle-cell retinopathy, unspecified eye (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H43.10 — Vitreous hemorrhage, unspecified eye (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H43.11 — Vitreous hemorrhage, right eye (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H43.12 — Vitreous hemorrhage, left eye (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), H43.13 — Vitreous hemorrhage, bilateral (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), +194 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Sickle cell trait/anemia, Retinal and vitreous conditions).

D57.451 — Sickle-cell thalassemia beta plus with acute chest syndrome, D57.452 — Sickle-cell thalassemia beta plus with splenic sequestration, D57.453 — Sickle-cell thalassemia beta plus with cerebral vascular involvement, D57.454 — Sickle-cell thalassemia beta plus with dactylitis, D57.458 — Sickle-cell thalassemia beta plus with crisis with other specified complication, D57.459 — Sickle-cell thalassemia beta plus with crisis, unspecified, D57.80 — Other sickle-cell disorders without crisis, D57.811 — Other sickle-cell disorders with acute chest syndrome, D57.812 — Other sickle-cell disorders with splenic sequestration, D57.813 — Other sickle-cell disorders with cerebral vascular involvement, D57.814 — Other sickle-cell disorders with dactylitis, D57.818 — Other sickle-cell disorders with crisis with other specified complication, D57.819 — Other sickle-cell disorders with crisis, unspecified, H36.811 — Nonproliferative sickle-cell retinopathy, right eye, H36.812 — Nonproliferative sickle-cell retinopathy, left eye, H36.813 — Nonproliferative sickle-cell retinopathy, bilateral, H36.819 — Nonproliferative sickle-cell retinopathy, unspecified eye, H36.821 — Proliferative sickle-cell retinopathy, right eye, H36.823 — Proliferative sickle-cell retinopathy, bilateral, H36.829 — Proliferative sickle-cell retinopathy, unspecified eye, +770 more

Contextual Map

Every relationship of H36.822 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 H36.822 with this related code in Claim Check

Hierarchy

Referenced by Excludes2 notes

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 108 — Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major [CMS-HCC]— CMS-HCC V28 · 2026
  • HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage [CMS-HCC]— CMS-HCC V28 · 2026

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 · FY2027

Nearest codes (12)

Change history

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 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 — v44 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release 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-derived 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 editorial 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

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. "H36.822 — Proliferative sickle-cell retinopathy, left eye." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/h36.822-proliferative-sickle-cell-retinopathy-left-eye

Change history

  • FY2024 — October 1, 2023
    Added to the code set
    Proliferative sickle-cell retinopathy, left eye
    FY2024 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to H36.822 in its code family, with their registry titles.

View all codes in the H36 family