H01.124 ICD-10-CM Code: Discoid lupus erythematosus of left upper eyelid
H01.124 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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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 guidanceDiscoid 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
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.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 317
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for H01.124. Check the code and parent instructions in the Code Book.
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59, H00-H05
- certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59, H00-H05
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59, H00-H05
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59, H00-H05
- diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59, H00-H05
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59, H00-H05
- injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59, H00-H05
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59, H00-H05
- neoplasms (C00-D49)Inherited from H00-H59, H00-H05
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59, H00-H05
- syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59, H00-H05
- open wound of eyelid (S01.1-)Inherited from H00-H59, H00-H05
- superficial injury of eyelid (S00.1-, S00.2-)Inherited from H00-H59, H00-H05
Related Codes
Includes
OfficialNo Includes notes are included in this display for H01.124. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for H01.124. Check the code and parent instructions in the Code Book.
Code First
OfficialNo Code First sequencing instructions are included in this display for H01.124. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for H01.124. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for H01.124. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 H01.124 an HCC code?
H01.124 is not in the CMS-HCC V28 or V24 community payment model. H01.124 has a separate mapping under the Part D RxHCC model (HCC 317 (Discoid Lupus Erythematosus)); the applicable result needs member context.
- Code
- H01.124
- Description
- Discoid lupus erythematosus of left upper eyelid
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work H01.124 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for H01.124
For H01.124, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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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 has no mapping under the CMS-HCC V28 or V24 community payment models. H01.124 has a separate mapping under the Part D RxHCC model (HCC 317 (Discoid Lupus Erythematosus)); the applicable result needs member context. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.
Ensure documentation clearly identifies the left upper eyelid as the affected site.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, 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