ICD-10 H20.011
Billable / Specific CCPrimary iridocyclitis, right eye
About ICD-10-CM H20.011
ICD-10-CM code H20.011 represents Primary iridocyclitis, right eye. This is a billable/specific code in the Eye and Adnexa chapter (block H20). The 2026 edition of ICD-10-CM H20.011 became effective on October 1, 2025.
Coding Tips for H20.011
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
H20.011 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inpatient DRG Impact, CC
codes Primary iridocyclitis, right eye. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for H20.011
Local Coverage Determinations (LCDs) from CMS MACs that list H20.011 as a covered diagnosis.
Showing top 10 of 61 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing H20.011.
5 Medicare
CPT Codes Commonly Billed with H20.011
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
Convert H20.011 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| H20.011 | 36401 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To H20.011
Other codes in section H15-H22 (Disorders of sclera, cornea, iris and ciliary body).
ICD-10 H20.011, Billing FAQ
Is ICD-10 code H20.011 billable? +
Yes, H20.011 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is H20.011 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with H20.011? +
Procedures frequently paired with H20.011 include: J1745, Q5104, Q5121, Q5103.
What ICD-9 codes does H20.011 map to? +
Per CMS GEMs, H20.011 maps to ICD-9 codes: 36401. Useful for legacy data review and historical claim analysis.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team