What is ICD-10 code H01.122?

H01.122 is the ICD-10-CM diagnosis code for Discoid lupus erythematosus of right lower eyelid. A chronic autoimmune skin condition (discoid lupus erythematosus) affecting the lower eyelid of the right eye. It belongs to the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59). H01.122 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H01.122 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. H01.122 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. H01.122 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.

Which HCC does H01.122 map to under V28?

H01.122 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

What does H01.122 pay in RAF?

H01.122 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

What is the V28 vs V24 difference for H01.122?

H01.122 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 community model rewards H01.122 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. It does, however, map under the Part D RxHCC model (Lupus, Cutaneous), which affects the ESRD and/or Part D (RxHCC) risk scores. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

What documentation supports H01.122?

Ensure the diagnosis specifies discoid lupus erythematosus localized to the eyelid Verify right eye and lower eyelid location in the clinical documentation H01.122 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

2026 ICD-10-CM H01.122: Discoid lupus erythematosus of right

H01.122 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC coding software

ICD-10-CM Code View

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Code lookupH01.122Effective 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)

H01.122

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

Discoid lupus erythematosus of right lower eyelid

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

Buddy Insight

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

N/A

—

Not risk-adjusted for this model/period.

Not mapped

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

Mapped

HCC 317

Lupus, Cutaneous

RAF 0.113

Code Book Path

Official

H01.1Noninfectious dermatoses of eyelid

H01.12Discoid lupus erythematosus of eyelid

H01.122Discoid lupus erythematosus of right lower eyelid

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for H01.122 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for H01.122 in this effective period.

Related Child Codes

Official

H01.121Discoid lupus erythematosus of right upper 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 H01.122 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for H01.122 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for H01.122 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for H01.122 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for H01.122 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Examination findings specific to the right lower eyelid with discoid lupus changes

Biopsy or clinical confirmation of discoid lupus erythematosus diagnosis

Assessment of lower eyelid function and tear drainage

Evaluation for cicatricial ectropion or other structural complications

MEAT Support

HCC Buddy guidance

Examination findings specific to the right lower eyelid with discoid lupus changes

Biopsy or clinical confirmation of discoid lupus erythematosus diagnosis

Assessment of lower eyelid function and tear drainage

Evaluation for cicatricial ectropion or other structural complications

Audit Caution

HCC Buddy guidance

Using skin-level discoid lupus codes instead of the eyelid-specific H01.12x codes

Not distinguishing upper from lower eyelid when documentation specifies the location

Failing to code bilateral involvement separately when both eyes are affected

Not documenting the specific eyelid affected during clinical examination

Common Mistakes

HCC Buddy guidance

H01.121 — Discoid lupus erythematosus of right upper eyelid: same side, different eyelid

H01.125 — Discoid lupus erythematosus of left lower eyelid: contralateral side, same eyelid

L93.0 — Discoid lupus erythematosus (skin): non-eyelid cutaneous involvement

H01.009 — Unspecified blepharitis, unspecified eye: non-lupus eyelid inflammation

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 H01.122 an HCC code?

H01.122 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Lupus, Cutaneous under the Part D RxHCC model.

Code: H01.122
Description: Discoid lupus erythematosus of right lower eyelid
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

RxHCCHCC 317, Lupus, Cutaneous

0.113

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work H01.122 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for H01.122

For H01.122 to 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 H01.122 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

H01.122 is the ICD-10-CM diagnosis code for discoid lupus erythematosus of right lower eyelid. A chronic autoimmune skin condition (discoid lupus erythematosus) affecting the lower eyelid of the right eye. H01.122 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).

H01.122 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.

This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing H01.122 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H01.122 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Ensure the diagnosis specifies discoid lupus erythematosus localized to the eyelid
•Verify right eye and lower eyelid location in the clinical documentation

Clinical Significance

Discoid lupus erythematosus of the right lower eyelid affects the lower eyelid with characteristic discoid lupus lesions that can cause scarring, eyelid malposition, and potential corneal complications from exposure. Lower eyelid involvement may be more visible and can cause functional problems with tear drainage and eyelid closure. Specific laterality and eyelid identification is required for accurate coding.

Documentation Requirements

✓Examination findings specific to the right lower eyelid with discoid lupus changes
✓Biopsy or clinical confirmation of discoid lupus erythematosus diagnosis
✓Assessment of lower eyelid function and tear drainage
✓Evaluation for cicatricial ectropion or other structural complications
✓Treatment plan and follow-up schedule

Commonly Confused Codes

•H01.121: Discoid lupus erythematosus of right upper eyelid: same side, different eyelid
•H01.125: Discoid lupus erythematosus of left lower eyelid: contralateral side, same eyelid
•L93.0: Discoid lupus erythematosus (skin): non-eyelid cutaneous involvement
•H01.009: Unspecified blepharitis, unspecified eye: non-lupus eyelid inflammation