What is ICD-10 code H01.126?

H01.126 is the ICD-10-CM diagnosis code for Discoid lupus erythematosus of left eye, unspecified eyelid. A chronic autoimmune skin condition affecting the left eye with discoid lupus erythematosus, but the specific eyelid location (upper or lower) is not documented. H01.126 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H01.126 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. H01.126 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. H01.126 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 H01.126?

H01.126 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 H01.126 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 H01.126?

Use this code only when the eyelid location cannot be determined from documentation Query the provider if possible to obtain more specific anatomical location for more precise coding

H01.126: Discoid lupus erythematosus of left eye, unspecified eyelid — ICD-10

ICD-10-CM Code View

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Code lookupH01.126Effective 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)

H01.126

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

Discoid lupus erythematosus of left eye, unspecified eyelid

A chronic autoimmune skin condition affecting the left eye with discoid lupus erythematosus, but the specific eyelid location (upper or lower) is not documented.

Buddy Insight

Discoid lupus erythematosus of left eye, unspecified eyelid captures lupus involvement of the left eye's eyelid when the specific eyelid (upper or lower) is not documented.

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

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

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for H01.126 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for H01.126 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

H01.124Discoid lupus erythematosus of left upper eyelid

H01.125Discoid lupus erythematosus of left lower eyelid

Includes

Official

ICD-10-CM does not list Includes notes for H01.126 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for H01.126 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for H01.126 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for H01.126 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for H01.126 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of discoid lupus affecting the left eye eyelid area

Clinical or biopsy confirmation of discoid lupus

Explanation of why the specific eyelid cannot be determined

Assessment of eyelid function and ocular surface status

MEAT Support

HCC Buddy guidance

Documentation of discoid lupus affecting the left eye eyelid area

Clinical or biopsy confirmation of discoid lupus

Explanation of why the specific eyelid cannot be determined

Assessment of eyelid function and ocular surface status

Audit Caution

HCC Buddy guidance

Using this code when the specific eyelid (upper or lower) is documented in the record

Defaulting to the completely unspecified code (H01.129) when the left eye laterality is known

Not querying the provider for eyelid specificity when examination findings could clarify

Applying right eye codes when the left eye is the affected side

Common Mistakes

HCC Buddy guidance

H01.124 — Discoid lupus erythematosus of left upper eyelid: more specific — use when upper eyelid is documented

H01.125 — Discoid lupus erythematosus of left lower eyelid: more specific — use when lower eyelid is documented

H01.129 — Discoid lupus erythematosus of unspecified eye, unspecified eyelid: even less specific, no laterality

H01.123 — Discoid lupus erythematosus of right eye, unspecified eyelid: contralateral side

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 H01.126 an HCC code?

No. H01.126 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.

Work H01.126 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for H01.126

For H01.126to 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 H01.126 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

H01.126 is the ICD-10-CM diagnosis code for discoid lupus erythematosus of left eye, unspecified eyelid. A chronic autoimmune skin condition affecting the left eye with discoid lupus erythematosus, but the specific eyelid location (upper or lower) is not documented. H01.126 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).

H01.126 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, H01.126 maps to RxHCC 317 (Lupus, Cutaneous) with a RAF weight of 0.0. No V28, V24, or ESRD HCC mappings exist. Risk adjustment impact is minimal from this code alone. Documentation improvement to specify the eyelid enhances clinical accuracy without changing the HCC mapping.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H01.126 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code only when the eyelid location cannot be determined from documentation
•Query the provider if possible to obtain more specific anatomical location for more precise coding

Clinical Significance

Discoid lupus erythematosus of left eye, unspecified eyelid captures lupus involvement of the left eye's eyelid when the specific eyelid (upper or lower) is not documented. This code preserves laterality information while noting the eyelid is unspecified. It should trigger a documentation improvement effort to identify the specific eyelid involved.

Documentation Requirements

✓Documentation of discoid lupus affecting the left eye eyelid area
✓Clinical or biopsy confirmation of discoid lupus
✓Explanation of why the specific eyelid cannot be determined
✓Assessment of eyelid function and ocular surface status
✓Treatment plan for the eyelid involvement

Commonly Confused Codes

•H01.124: Discoid lupus erythematosus of left upper eyelid: more specific: use when upper eyelid is documented
•H01.125: Discoid lupus erythematosus of left lower eyelid: more specific: use when lower eyelid is documented
•H01.129: Discoid lupus erythematosus of unspecified eye, unspecified eyelid: even less specific, no laterality
•H01.123: Discoid lupus erythematosus of right eye, unspecified eyelid: contralateral side