2027 ICD-10-CM Diagnosis Code H43.12Vitreous hemorrhage, left eye
ICD-10-CM Codes›H00–H59›H43-H44›H43
- Billable — Valid for Submission
- Risk Adjusts — HCC 298
- Chronic Condition
H43.12 is a billable ICD-10-CM diagnosis code for vitreous hemorrhage, left eye. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 124 through 125. Coders also document this condition as ghost cell glaucoma. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Retinal and vitreous conditions.
For Medicare Advantage risk adjustment, H43.12 maps to CMS-HCC Category 298 (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage) under the V28 model, adding a risk factor of about 0.336 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
H43.12 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Ghost cell glaucoma
- Ghost cell glaucoma of left eye
- Ghost cell ocular hypertension
- Ghost cell ocular hypertension of left eye
- Hemorrhage of left vitreous body
- Vitreous hemorrhage due to diabetes mellitus
- Vitreous hemorrhage of left eye due to diabetes mellitus
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to H43.12: its own notes plus those printed at Chapter 7. A note printed at a category, block or chapter applies to every code under it.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may 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)
Notes
General instructions on how these codes are used.
- Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Vitreous Hemorrhage
hemorrhage into the vitreous body.
Patient EducationClinical
Eye Diseases
Even if your eyes feel healthy, you could have a problem and not know it. That's why regular eye exams are so important. Refractive errors are the most common type of vision problem that makes it hard to see clearly. But some eye conditions or diseases don't have any symptoms and can lead to a permanent loss of vision.
The full article covers:
- What diseases can affect the eye?
- What are the symptoms of eye diseases?
- Who is more likely to develop eye diseases?
- What are the treatments for eye diseases?
- Can eye diseases be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert H43.12 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About H43.12Overview
What is the ICD-10 code for vitreous hemorrhage, left eye?
The ICD-10-CM code for vitreous hemorrhage, left eye is H43.12 (sometimes written as H4312). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is H43.12 (Vitreous hemorrhage) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report vitreous hemorrhage, left eye on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does H43.12 group to?
When vitreous hemorrhage, left eye is the principal diagnosis on an inpatient stay, it groups to MS-DRG 125, 124, with relative weights from 0.7699 to 1.2470 depending on complications. Higher weights mean higher Medicare reimbursement.
What is the ICD-9 equivalent of H43.12?
Under the General Equivalence Mappings, vitreous hemorrhage, left eye converts to ICD-9-CM 379.23 (vitreous hemorrhage). The mapping is approximate, so confirm the match fits the documentation.
What HCC is H43.12?
H43.12 (vitreous hemorrhage, left eye) maps to CMS-HCC Category 298 (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage), commonly written as HCC 298, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 122 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does H43.12 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, H43.12 adds a risk adjustment factor of about 0.336 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.301 to 0.545 depending on the payment segment). HCC 298 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 298 category page.
