A54.39 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupA54.39

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Infections with a predominantly sexual mode of transmission (A50-A64)

A54.39

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other gonococcal eye infection

This code describes a gonorrheal infection of the eye that doesn't fit into the more common categories of acute conjunctivitis or neonatal ophthalmia. It may include conditions like gonococcal keratitis, iritis, or other inflammatory eye conditions caused by the gonorrhea bacteria.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

A54Gonococcal infection A54.3Gonococcal infection of eye A54.39Other gonococcal eye infection

Inclusion Terms

Official

Gonococcal endophthalmia

Excludes 2

Official

carrier or suspected carrier of infectious disease (Z22.-)Inherited from A00-B99, A50-A64
infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium (O98.-)Inherited from A00-B99, A50-A64
infectious and parasitic diseases specific to the perinatal period (P35-P39)Inherited from A00-B99, A50-A64
influenza and other acute respiratory infections (J00-J22)Inherited from A00-B99, A50-A64
human immunodeficiency virus [HIV] disease (B20)Inherited from A00-B99, A50-A64

Related Codes

Official

A54.30Gonococcal infection of eye, unspecified A54.31Gonococcal conjunctivitis A54.32Gonococcal iridocyclitis A54.33Gonococcal keratitis

Includes

Official

diseases generally recognized as communicable or transmissibleInherited from A00-B99

Excludes 1

Official

certain localized infections - see body system-related chaptersInherited from A00-B99, A50-A64
nonspecific and nongonococcal urethritis (N34.1)Inherited from A00-B99, A50-A64
Reiter's disease (M02.3-)Inherited from A00-B99, A50-A64

Code First

Official

No Code First sequencing instructions are included in this display for A54.39. Check the code and parent instructions in the Code Book.

Use Additional

Official

code to identify resistance to antimicrobial drugs (Z16.-)Inherited from A00-B99

Code Also

Official

No Code Also instructions are included in this display for A54.39. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Verify the specific type of gonococcal eye infection documented in the medical record, as more specific codes (A54.30, A54.31) may be more appropriate for conjunctivitis or neonatal cases

Ensure the diagnosis clearly documents gonorrhea as the causative organism and confirms the eye as the affected site; coordinate with ophthalmology documentation if available

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is A54.39 an HCC code?

No. A54.39 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: A54.39
Description: Other gonococcal eye infection
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

A54.39 is the ICD-10-CM diagnosis code for other gonococcal eye infection. This code describes a gonorrheal infection of the eye that doesn't fit into the more common categories of acute conjunctivitis or neonatal ophthalmia. It may include conditions like gonococcal keratitis, iritis, or other inflammatory eye conditions caused by the gonorrhea bacteria. A54.39 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering infections with a predominantly sexual mode of transmission (a50-a64).

A54.39 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Verify the specific type of gonococcal eye infection documented in the medical record, as more specific codes (A54.30, A54.31) may be more appropriate for conjunctivitis or neonatal cases.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for A54.39 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify the specific type of gonococcal eye infection documented in the medical record, as more specific codes (A54.30, A54.31) may be more appropriate for conjunctivitis or neonatal cases
•Ensure the diagnosis clearly documents gonorrhea as the causative organism and confirms the eye as the affected site; coordinate with ophthalmology documentation if available