What is ICD-10 code H01.121?

H01.121 is the ICD-10-CM diagnosis code for Discoid lupus erythematosus of right upper eyelid. A chronic autoimmune skin condition (discoid lupus erythematosus) affecting the upper eyelid of the right eye. It belongs to the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59). H01.121 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H01.121 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.

Yes. H01.121 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. H01.121 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.

What is the V28 vs V24 difference for H01.121?

H01.121 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 H01.121 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.

What should coders know when reporting H01.121?

Confirm diagnosis of discoid lupus erythematosus (DLE) rather than systemic lupus erythematosus (SLE) Document right eye and upper eyelid involvement to support this specific code

H01.121: Discoid lupus erythematosus of right

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupH01.121Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of eyelid, lacrimal system and orbit (H00-H05)

H01.121

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

Discoid lupus erythematosus of right upper eyelid

A chronic autoimmune skin condition (discoid lupus erythematosus) affecting the upper eyelid of the right eye.

Buddy Insight

Discoid lupus erythematosus of the right upper eyelid represents a chronic autoimmune skin condition affecting the eyelid, causing scarring, pigmentary changes, and potential eyelid dysfunction.

CMS-HCC V28

Not risk-adjusted for this model/period.

RAF 0

CMS-HCC V24

Not risk-adjusted for this model/period.

RAF 0

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Not risk-adjusted for this model/period.

RAF 0

RXHCC

Mapped

HCC 317

Lupus, Cutaneous

RAF 0.0

Code Trumping

Basket needed

Compare selected patient codes to show trumped or trumps impact.

Code Book Path

Official

H01.1Noninfectious dermatoses of eyelid

H01.12Discoid lupus erythematosus of eyelid

H01.121Discoid lupus erythematosus of right upper eyelid

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for H01.121 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for H01.121 in this effective period.

Related Child Codes

Official

H01.122Discoid lupus erythematosus of right lower eyelid

H01.123Discoid lupus erythematosus of right eye, unspecified eyelid

H01.124Discoid lupus erythematosus of left upper eyelid

H01.125Discoid lupus erythematosus of left lower eyelid

H01.126Discoid lupus erythematosus of left eye, unspecified eyelid

Includes

Official

ICD-10-CM does not list Includes notes for H01.121 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for H01.121 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for H01.121 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for H01.121 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for H01.121 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Examination findings specific to the right upper eyelid (erythematous plaques, scarring, dyspigmentation)

Documentation confirming discoid lupus diagnosis (biopsy results or dermatological consultation)

Assessment of eyelid function and any secondary complications (cicatricial changes, exposure keratopathy)

Evaluation for systemic lupus erythematosus features

MEAT Support

HCC Buddy guidance

Examination findings specific to the right upper eyelid (erythematous plaques, scarring, dyspigmentation)

Documentation confirming discoid lupus diagnosis (biopsy results or dermatological consultation)

Assessment of eyelid function and any secondary complications (cicatricial changes, exposure keratopathy)

Evaluation for systemic lupus erythematosus features

Audit Caution

HCC Buddy guidance

Using the generic skin discoid lupus code (L93.0) when the eyelid is specifically affected — the H01.12x codes are more appropriate

Not specifying laterality (right vs left) and location (upper vs lower eyelid) when documented

Defaulting to unspecified eye or eyelid codes when the documentation clearly identifies the specific eyelid

Failing to evaluate and document whether systemic lupus erythematosus criteria are met

Common Mistakes

HCC Buddy guidance

H01.122 — Discoid lupus erythematosus of right lower eyelid: different eyelid location, same side

H01.124 — Discoid lupus erythematosus of left upper eyelid: same eyelid but contralateral side

L93.0 — Discoid lupus erythematosus (skin): use for non-eyelid cutaneous discoid lupus

H01.019 — Ulcerative blepharitis of unspecified eye: different etiology, infectious rather than autoimmune

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is H01.121 an HCC code?

No. H01.121 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.

HCC Category Mapping

RxHCCHCC 317, Lupus, Cutaneous

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for H01.121

For H01.121to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed H01.121 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

H01.121 is the ICD-10-CM diagnosis code for discoid lupus erythematosus of right upper eyelid. A chronic autoimmune skin condition (discoid lupus erythematosus) affecting the upper eyelid of the right eye. H01.121 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of eyelid, lacrimal system and orbit (h00-h05).

H01.121 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

In the RxHCC model, H01.121 maps to RxHCC 317 (Lupus, Cutaneous) with a RAF weight of 0.0 in the community model. This code does not map to HCCs in V28, V24, or ESRD models. The RxHCC mapping recognizes the medication management implications of cutaneous lupus, even though the community RAF weight is zero. The primary risk adjustment value comes from any associated systemic lupus codes.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H01.121 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Confirm diagnosis of discoid lupus erythematosus (DLE) rather than systemic lupus erythematosus (SLE)
•Document right eye and upper eyelid involvement to support this specific code

Clinical Significance

Discoid lupus erythematosus of the right upper eyelid represents a chronic autoimmune skin condition affecting the eyelid, causing scarring, pigmentary changes, and potential eyelid dysfunction. Eyelid involvement in discoid lupus is clinically significant because it can cause cicatricial ectropion, entropion, madarosis (eyelash loss), and corneal exposure. Accurate documentation of laterality and location is essential for appropriate coding and ophthalmic management.

Documentation Requirements

✓Examination findings specific to the right upper eyelid (erythematous plaques, scarring, dyspigmentation)
✓Documentation confirming discoid lupus diagnosis (biopsy results or dermatological consultation)
✓Assessment of eyelid function and any secondary complications (cicatricial changes, exposure keratopathy)
✓Evaluation for systemic lupus erythematosus features
✓Treatment plan for the eyelid involvement (topical therapy, intralesional injection, surgical intervention)

Commonly Confused Codes

•H01.122: Discoid lupus erythematosus of right lower eyelid: different eyelid location, same side
•H01.124: Discoid lupus erythematosus of left upper eyelid: same eyelid but contralateral side
•L93.0: Discoid lupus erythematosus (skin): use for non-eyelid cutaneous discoid lupus
•H01.019: Ulcerative blepharitis of unspecified eye: different etiology, infectious rather than autoimmune