What is ICD-10 code H01.124?

H01.124 is the ICD-10-CM diagnosis code for Discoid lupus erythematosus of left upper eyelid. A chronic autoimmune skin condition affecting the upper eyelid of the left eye, characterized by inflammation and potential scarring from discoid lupus erythematosus. H01.124 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H01.124 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. H01.124 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. H01.124 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 H01.124?

H01.124 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 H01.124 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 H01.124?

Ensure documentation clearly identifies the left upper eyelid as the affected site DLE of the eyelid may be associated with systemic lupus; review records for any SLE diagnosis that might require additional coding

H01.124 ICD-10 Code: Discoid lupus erythematosus

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 lookupH01.124Effective 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)

H01.124

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

Discoid lupus erythematosus of left upper eyelid

A chronic autoimmune skin condition affecting the upper eyelid of the left eye, characterized by inflammation and potential scarring from discoid lupus erythematosus.

Buddy Insight

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

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Code Book Path

Official

H01.1Noninfectious dermatoses of eyelid

H01.12Discoid lupus erythematosus of eyelid

H01.124Discoid lupus erythematosus of left upper eyelid

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for H01.124 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for H01.124 in this effective period.

Related Child Codes

Official

H01.121Discoid lupus erythematosus of right upper eyelid

H01.122Discoid lupus erythematosus of right lower eyelid

H01.123Discoid lupus erythematosus of right eye, unspecified 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 H01.124 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for H01.124 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for H01.124 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for H01.124 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for H01.124 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Clinical examination documenting discoid lupus findings specific to the left upper eyelid

Histopathological confirmation through biopsy when available

Assessment of eyelid closure function and corneal health

Evaluation for other cutaneous and systemic lupus manifestations

MEAT Support

HCC Buddy guidance

Clinical examination documenting discoid lupus findings specific to the left upper eyelid

Histopathological confirmation through biopsy when available

Assessment of eyelid closure function and corneal health

Evaluation for other cutaneous and systemic lupus manifestations

Audit Caution

HCC Buddy guidance

Confusing laterality — using right-side codes for left-side involvement

Using generic blepharitis codes when discoid lupus has been specifically diagnosed

Not specifying both the side and eyelid location when documentation supports it

Failing to separately code additional eyelids if multiple eyelids are involved

Common Mistakes

HCC Buddy guidance

H01.121 — Discoid lupus erythematosus of right upper eyelid: contralateral side

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

H01.126 — Discoid lupus erythematosus of left eye, unspecified eyelid: less specific version for left eye

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

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 H01.124 an HCC code?

No. H01.124 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 H01.124

For H01.124to 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 H01.124 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

H01.124 is the ICD-10-CM diagnosis code for discoid lupus erythematosus of left upper eyelid. A chronic autoimmune skin condition affecting the upper eyelid of the left eye, characterized by inflammation and potential scarring from discoid lupus erythematosus. H01.124 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).

H01.124 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, H01.124 maps to RxHCC 317 (Lupus, Cutaneous) with a RAF weight of 0.0. No V28, V24, or ESRD HCC mappings exist for this code. The risk adjustment impact is through medication management implications captured by the RxHCC model. Primary risk adjustment value depends on whether systemic lupus erythematosus is also present.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H01.124 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Ensure documentation clearly identifies the left upper eyelid as the affected site
•DLE of the eyelid may be associated with systemic lupus; review records for any SLE diagnosis that might require additional coding

Clinical Significance

Discoid lupus erythematosus of the left upper eyelid represents autoimmune-mediated chronic skin disease affecting the left upper eyelid, with potential for scarring, eyelid dysfunction, and secondary ocular surface compromise. Upper eyelid involvement is particularly significant because it can affect eyelid closure and corneal protection. Monitoring for progression to systemic lupus erythematosus is clinically important.

Documentation Requirements

✓Clinical examination documenting discoid lupus findings specific to the left upper eyelid
✓Histopathological confirmation through biopsy when available
✓Assessment of eyelid closure function and corneal health
✓Evaluation for other cutaneous and systemic lupus manifestations
✓Treatment documentation including topical, intralesional, or systemic therapy

Commonly Confused Codes

•H01.121: Discoid lupus erythematosus of right upper eyelid: contralateral side
•H01.125: Discoid lupus erythematosus of left lower eyelid: same side, different eyelid
•H01.126: Discoid lupus erythematosus of left eye, unspecified eyelid: less specific version for left eye
•L93.0: Discoid lupus erythematosus: non-eyelid cutaneous involvement