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H31.411

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🧬 ICD-10 CM H31.411 - Hemorrhagic choroidal detachment, right eye

Overview

ICD-10 CM H31.411 classifies hemorrhagic choroidal detachment of the right eye. This condition involves blood accumulation in the suprachoroidal space, separating the choroid from the sclera. It is often associated with ocular surgery (e.g., glaucoma or retinal procedures), trauma, severe hypotony, or vascular abnormalities and can present with acute pain, decreased vision, and shallow anterior chamber.

ICD-10 CM H31.411 is a billable/specific diagnosis code used when the documentation confirms hemorrhagic choroidal detachment and specifies the right eye. Because this is a vision-threatening condition that may require urgent intervention, accurate coding supports medical necessity for imaging, close monitoring, and potential surgical drainage.ICD-10-CM Tabular List 2025

Code breakdown

The structure of H31.411 within ICD-10-CM:

SegmentValueDescription
ChapterH00-H59Diseases of the eye and adnexa
BlockH30-H36Disorders of choroid and retina
CategoryH31Other disorders of choroid
SubcategoryH31.4Choroidal detachment
GroupH31.41Hemorrhagic choroidal detachment
Laterality1Right eye

Laterality specifics (H31.41x family)

Laterality requirement

When the affected eye is documented, use the corresponding laterality-specific code. For hemorrhagic choroidal detachment of the right eye, H31.411 is the correct code. Avoid unspecified-eye codes (e.g., H31.419) when laterality is clearly documented in the record.ICD-10-CM Official Guidelines FY 2025

Coding guidelines

Includes

Use H31.411 when documentation supports:

  • Hemorrhagic choroidal detachment, right eye
  • Hemorrhagic detachment of right choroid
  • Choroidal hemorrhage with detachment, right eye, when clearly described as a hemorrhagic detachment rather than isolated hemorrhage
  • Postoperative hemorrhagic choroidal detachment of the right eye (e.g., after glaucoma filtering surgery, cataract surgery, or vitrectomy), when the hemorrhagic detachment is the primary manifestation being treated

These conditions fall under the hemorrhagic choroidal detachment concept for the right eye.ICD10Data - H31.411

Excludes

Do not use H31.411 when a more appropriate code exists:

  • Non-hemorrhagic choroidal detachment (e.g., serous or non-specified effusion):
    • Unspecified choroidal detachment, right eye → H31.401
  • Retinal detachment (not choroidal):
    • Retinal detachment with retinal break → H33.0- (e.g., H33.001)
    • Serous retinal detachment → H33.2-
    • Traction retinal detachment → H33.4-
  • Retinal breaks without detachment → H33.3-
  • Isolated choroidal hemorrhage or rupture without detachment → codes in H31.3- (choroidal hemorrhage and rupture)
  • Injury-related conditions better captured by injury codes:
    • Injury of eye and orbit → S05.- (e.g., S05.1x- for contusion of eyeball and orbital tissues)
  • Congenital ocular anomalies → Q14.- (congenital malformations of posterior segment of eye)

NOTE

If documentation clearly states choroidal hemorrhage without detachment, use a code from H31.3- rather than H31.411. If both hemorrhage and detachment are present and described as a hemorrhagic detachment, H31.411 is appropriate.

Use of additional codes

H31.411 may be reported with additional codes to fully describe the clinical scenario:

  • Visual impairment:
    • Add codes from H54.- to capture degree of vision loss when documented (e.g., H54.10 for unspecified severe visual impairment, one eye; unspecified visual impairment, other eye).
  • Underlying cause / associated conditions:
    • Hypotony of eye → H44.4-
    • Inflammatory conditions (e.g., uveitis) → appropriate H2x/H3x codes
    • Systemic autoimmune disease (e.g., rheumatoid arthritis, lupus) → M05.-, M32.-, etc.
  • Postoperative status / device status:
    • Prior ocular surgery or implants: Z98.4 (Cataract extraction status), Z96.1 (Presence of intraocular lens), or other relevant Z-codes.
  • External cause (if traumatic):
    • Use external cause codes to identify mechanism of injury (e.g., W21.03x for struck by baseball, W20.8x for struck by other object) and injury codes such as S05.1x- (contusion of eyeball and orbital tissues) when applicable.

These additional codes support medical necessity, clarify etiology, and improve risk and utilization profiling.ICD-10-CM External Cause Index 2025

Risk adjustment (HCC)

  • HCC Status: No
  • Model: CMS-HCC V28
  • RAF Impact: H31.411 does not map to a CMS-HCC under the current V28 model and therefore does not directly increase the patient’s risk adjustment factor.

Clinical relevance:
Despite not being an HCC, hemorrhagic choroidal detachment is a serious, vision-threatening condition that may require urgent surgical or procedural intervention, intensive monitoring, and significant resource utilization. Accurate documentation and coding remain important for quality metrics, utilization review, and clinical analytics.CMS-HCC Model V28 Summary

Inpatient impact (MS-DRG)

For inpatient claims, H31.411 is grouped into MS-DRGs for “Other disorders of the eye” when used as the principal or a significant secondary diagnosis:

  • MS-DRG 124: Other disorders of the eye with MCC or thrombolytic agent

  • MS-DRG 125: Other disorders of the eye without MCC

  • CC/MCC Status: Non-CC (does not count as a complication/comorbidity by itself)

Impact:
H31.411 generally does not move a case into a higher severity tier on its own, but it supports medical necessity for admissions related to hemorrhagic choroidal detachment management, including surgical drainage, control of hypotony, and complex postoperative care. MCC/CC conditions elsewhere in the record will drive DRG severity level.CMS MS-DRG Definitions Manual v43

Code tree

Chapter 7: Diseases of the Eye and Adnexa (H00-H59)
└── Disorders of choroid and retina (H30-H36)
    └── Other disorders of choroid (H31)
        └── Choroidal detachment (H31.4)
            └── H31.41  Hemorrhagic choroidal detachment
                └── H31.411  Hemorrhagic choroidal detachment, right eye
                └── H31.412  Hemorrhagic choroidal detachment, left eye
                └── H31.413  Hemorrhagic choroidal detachment, bilateral
                └── H31.419  Hemorrhagic choroidal detachment, unspecified eye

Clinical coding examples

Example 1: Postoperative hemorrhagic choroidal detachment, right eye

Scenario: A patient presents with severe eye pain and decreased vision one day after trabeculectomy in the right eye. Exam shows hemorrhagic choroidal detachment, right eye with hypotony.

Coding:

  • Primary: H31.411 (Hemorrhagic choroidal detachment, right eye)

  • Secondary: H44.4- (hypotony of eye), if documented

  • Additional: Z98.89 (Other specified postprocedural states) or a more specific postoperative status code if documented

If the documentation specifies the exact type of glaucoma surgery and postoperative complication, additional codes may be used per guidelines.

Example 2: Traumatic hemorrhagic choroidal detachment, right eye

Scenario: Patient is struck in the right eye by a baseball. B-scan ultrasound confirms hemorrhagic choroidal detachment, right eye.

Coding:

  • Primary: H31.411

  • Secondary: S05.1x- (Contusion of eyeball and orbital tissues, right eye), if documented

  • External cause: W21.03x (Struck by baseball), plus place-of-occurrence/activity codes as applicable

Documentation should clearly link the trauma to the hemorrhagic choroidal detachment and specify laterality (right eye).

Example 3: Hemorrhagic choroidal detachment with visual impairment

Scenario: Patient with hemorrhagic choroidal detachment, right eye has documented severe visual impairment in that eye.

Coding:

  • Primary: H31.411

  • Secondary: H54.10 or another appropriate H54.- code based on the documented level and laterality of visual impairment.

Example 4: Bilateral vs unilateral coding distinction

Scenario: Initial note states “hemorrhagic choroidal detachment” without laterality; later addendum clarifies “right eye only.”

Coding:

  • Use H31.411 once laterality is clarified.

  • Do not use H31.413 (bilateral) unless both eyes are involved.

  • Avoid H31.419 when the record clearly specifies the right eye.

Revenue cycle considerations

  • wRVU: Not applicable. ICD-10-CM diagnosis codes do not carry work RVUs; wRVUs are assigned to CPT/HCPCS procedure codes.

  • Assistant payable: Not applicable. Assistant-at-surgery status applies to surgical CPT codes, not diagnosis codes.

  • Denial risk:

    • Risk increases if documentation supports hemorrhagic choroidal detachment but laterality is missing or inconsistent.

    • Payers may question medical necessity if high-intensity services (e.g., surgery, imaging) are billed without a clearly documented, specific diagnosis like H31.411.

  • Prior authorization:

    • Procedures related to hemorrhagic choroidal detachment (e.g., drainage of choroidal effusion/hemorrhage, associated retinal surgery) may require prior authorization.

    • H31.411 supports medical necessity when documentation clearly links the procedure to the hemorrhagic detachment.

  • Other choroidal detachment codes:

    • H31.401: Unspecified choroidal detachment, right eye

    • H31.402: Unspecified choroidal detachment, left eye

    • H31.403: Unspecified choroidal detachment, bilateral

    • H31.409: Unspecified choroidal detachment, unspecified eye

  • Other hemorrhagic choroidal detachment codes:

    • H31.412: Hemorrhagic choroidal detachment, left eye

    • H31.413: Hemorrhagic choroidal detachment, bilateral

    • H31.419: Hemorrhagic choroidal detachment, unspecified eye

  • Retinal detachments and breaks (not choroidal):

    • H33.0-: Retinal detachment with retinal break (e.g., H33.001)

    • H33.2-: Serous retinal detachment

    • H33.3-: Retinal breaks without detachment

    • H33.4-: Traction detachment of retina

  • Visual impairment:

    • H54.-: Blindness and low vision

  • Injury and external cause (if traumatic):

    • S05.1x-: Contusion of eyeball and orbital tissues

    • W21.03x: Struck by baseball

    • W20.8x: Struck by other object

Clinical management notes

Management of hemorrhagic choroidal detachment (including cases coded with H31.411) typically involves:American Academy of Ophthalmology

  • Stabilization and evaluation:

    • Assess intraocular pressure, anterior chamber depth, and visual acuity.

    • Perform B-scan ultrasonography when media opacity limits fundus view.

  • Identify and treat underlying cause:

    • Control hypotony (e.g., address wound leak, adjust filtration bleb, modify glaucoma medications).

    • Manage associated trauma or surgical complications.

  • Medical management:

    • Cycloplegic agents to deepen anterior chamber and reduce ciliary spasm.

    • Topical and/or systemic steroids when inflammatory components are present.

  • Surgical intervention (when indicated):

    • Drainage of choroidal hemorrhage/effusion via posterior sclerotomy or other techniques.

    • Concurrent management of associated retinal detachment or other posterior segment pathology if present.

  • Monitoring:

    • Serial examinations to monitor resolution or progression.

    • Repeat imaging as needed to guide timing of intervention.

Documentation should clearly describe laterality (right eye), hemorrhagic nature, severity, underlying cause, and any associated retinal or optic nerve involvement to support accurate coding and medical necessity.

Diagnostic testing support

Common diagnostic tests that support a diagnosis of hemorrhagic choroidal detachment include:

  • B-scan ultrasonography (ophthalmic ultrasound; often reported with codes such as 76512 when appropriate)

  • Fundus examination / ophthalmoscopy (e.g., extended ophthalmoscopy 92201/92202 depending on payer and year)

  • Optical Coherence Tomography (OCT) of retina → 92134

  • Fundus photography → 92250

These tests help confirm the presence, extent, and evolution of hemorrhagic choroidal detachment and may be used to monitor response to treatment.AAO Preferred Practice Pattern

CMS ICD-10-CM Official Guidelines for Coding and Reporting FY 2025 NCHS ICD-10-CM Tabular List 2025 ICD10Data.com - H31.411 ICD List - H31.411 ICD-10 Coded - H31.411 CMS MS-DRG Definitions Manual v43 CMS-HCC Risk Adjustment Model V28 Summary American Academy of Ophthalmology Preferred Practice Pattern

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