2026 ICD-10-CM Diagnosis Code H36.811Nonproliferative sickle-cell retinopathy, right eye

ICD-10-CM Codes›H00–H59›H30-H36›H36

ICD-10-CM H36.811
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

H36.811 is a billable ICD-10-CM diagnosis code for nonproliferative sickle-cell retinopathy, right eye. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 124 through 125. The code is not accepted as a principal diagnosis by the Medicare Code Editor. Coders also document this condition as nonproliferative retinopathy of right eye due to sickle cell disease. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Retinal and vitreous conditions and Sickle cell trait/anemia.

Code Identity

ICD-10-CM Code
H36.811
Billable Status
Yes — Valid for Submission
Code Describes
Nonproliferative sickle-cell retinopathy, right eye
Short Description
Nonproliferative sickle-cell retinopathy, right eye
Same as the full description in the CMS dataset.
Parent Code
H36.81
Nonproliferative sickle-cell retinopathy

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH30-H36Disorders of choroid and retina
CategoryH36Retinal disorders in diseases classified elsewhere
This CodeH36.811Nonproliferative sickle-cell retinopathy, right eye

Code EditsBilling

Medicare Code Editor checks that affect claim validity for H36.811.

Unacceptable principal diagnosis
There are selected codes that describe a circumstance which influences an individual's health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Nonproliferative retinopathy of right eye due to sickle cell disease
  • Nonproliferative sickle cell retinopathy
  • Sickle cell retinopathy

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR EYE005
Retinal and vitreous conditions
Default principal diagnosis: inpatient No · outpatient No
CCSR BLD005
Sickle cell trait/anemia
Default principal diagnosis: inpatient No · outpatient Yes

Code History & ChangesHistory

Replacement H36.811 replaces the following previously assigned code(s):

  • H35.20 - Other non-diabetic proliferative retinopathy, unsp eye
  • H35.23 - Other non-diabetic proliferative retinopathy, bilateral
FY 2024AddedAdded to the ICD-10-CM code setEffective October 1, 2023.
FY 2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About H36.811Overview

Is H36.811 (Nonproliferative sickle-cell retinopathy) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report nonproliferative sickle-cell retinopathy, right eye on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does H36.811 group to?

On inpatient claims, nonproliferative sickle-cell retinopathy, right eye maps to MS-DRG 124, 125, with relative weights from 0.7678 to 1.3231 depending on complications. Higher weights mean higher Medicare reimbursement.

Can H36.811 be a principal diagnosis?

No. The Medicare Code Editor rejects this code as a principal diagnosis because nonproliferative sickle-cell retinopathy, right eye describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.

Footnotes

[1] Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:

  • The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
  • The condition places limitations on self-care, independent living, and social interactions.