H36.813 — Nonproliferative sickle-cell retinopathy, bilateral
Is H36.813 billable?
Yes — H36.813 is billable for FY2027. H36.813 is a valid, billable ICD-10-CM code at the highest level of specificity in its branch. H36.813 may be submitted for encounters from October 1, 2026 through September 30, 2027.
H36.813 at a glance
| Code | H36.813 |
|---|---|
| Description | Nonproliferative sickle-cell retinopathy, bilateral |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to H36.813?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name H36.813 directly.
CMS will reject this code as the principal diagnosis on an inpatient claim. It describes something other than the condition chiefly responsible for the admission.
Which MS-DRGs does H36.813 group to?
H36.813 sits in MDC 02 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 124Other Disorders of the Eye with MCC or Thrombolytic Agentmedical
- 125Other Disorders of the Eye without MCCmedical
How is H36.813 listed in the Alphabetic Index?
The Alphabetic Index lists these routes under H36.81, the nearest indexed parent of H36.813. Use them to find the family, then select the specific code.
- Retinopathy › in › sickle-cell disorders › nonproliferative (background)
Excludes1 — never code together — inherited from H36
The conditions below can never be reported together with H36.813 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
Code first — inherited from H36
The underlying condition below must be sequenced before H36.813. H36.813 describes a manifestation and cannot be the principal or first-listed diagnosis.
Excludes2 — not included here — inherited from Chapter 7
The conditions below are not part of H36.813, but a patient may have both at the same time. When documentation supports it, H36.813 and the excluded code may both be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury (trauma) of eye and orbit (S05.-)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
- syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)
How long has H36.813 existed?
H36.813 first appears in FY2024.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.