Question 1

What is ICD-10 code H00.011?

Accepted Answer

H00.011 is the ICD-10-CM diagnosis code for Hordeolum externum right upper eyelid. It belongs to the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59). H00.011 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H00.011 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Question 2

Is H00.011 an HCC code?

Accepted Answer

No. H00.011 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H00.011 billable?

Accepted Answer

Yes. H00.011 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. H00.011 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for H00.011?

Accepted Answer

H00.011 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards H00.011 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting H00.011?

Accepted Answer

Verify laterality (right vs. left) and eyelid location (upper vs. lower) in the documentation before assigning the code, as these are essential specificity requirements Distinguish between hordeolum externum (external stye affecting eyelash follicles) and hordeolum internum (internal stye affecting meibomian glands) as they have different code assignments

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H00.011

Is H00.011 an HCC code?

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