H31.012 — Macula scars of posterior pole (postinflammatory) (post-traumatic), left eye
H31.012 is a billable, specific ICD-10-CM code for macula scars of posterior pole (postinflammatory) (post-traumatic), left eye. It is valid for submission on a claim.
Risk adjustment
H31.012 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
H31.012 is named in 12 Medicare coverage policies — 12 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
- A56672Billing and Coding: Electroretinography (ERG)
- A56726Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Code history
H31.012 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share H31.01. If H31.012 is not quite right, the correct code is usually one of these.
Questions about H31.012
- Is H31.012 a billable ICD-10-CM code?
- Yes. H31.012 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does H31.012 sit in the tabular list?
- Diseases of the eye and adnexa (H00-H59), in the block Disorders of choroid and retina (H30-H36).