Question 1

What is ICD-10 code H02.039?

Accepted Answer

H02.039 is the ICD-10-CM diagnosis code for Senile entropion of unspecified eye, unspecified eyelid. It belongs to the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59). H02.039 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H02.039 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.

Question 2

Is H02.039 an HCC code?

Accepted Answer

No. H02.039 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H02.039 billable?

Accepted Answer

Yes. H02.039 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. H02.039 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.

Question 4

What is the V28 vs V24 difference for H02.039?

Accepted Answer

H02.039 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 H02.039 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.

Question 5

What should coders know when reporting H02.039?

Accepted Answer

Verify whether the condition affects the right eye, left eye, or both eyes, as more specific codes (H02.031 for right eye, H02.032 for left eye, H02.033 for bilateral) should be used when this information is documented Confirm the eyelid location (upper or lower) is documented; if specified, use the appropriate fifth character code rather than 'unspecified' to ensure accurate billing and clinical documentation

H02.039

Is H02.039 an HCC code?

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