Question 1

What is ICD-10 code H02.043?

Accepted Answer

H02.043 is the ICD-10-CM diagnosis code for spastic entropion of right eye, unspecified eyelid. The eyelid of the right eye turns inward due to muscle spasm, causing the eyelashes to rub against the eye surface. The specific eyelid location is not specified. H02.043 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).

H02.043 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.

Use this code when spastic entropion is documented but the eyelid location is unclear.

Question 2

Is H02.043 an HCC code?

Accepted Answer

No. H02.043 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 H02.043 billable?

Accepted Answer

Yes. H02.043 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. H02.043 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 H02.043?

Accepted Answer

H02.043 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 H02.043 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 H02.043?

Accepted Answer

Use this code when spastic entropion is documented but the eyelid location is unclear Attempt to obtain clarification on whether upper or lower eyelid is affected for more specific coding

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H02.043

Is H02.043 an HCC code?

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H02.043 ICD-10-CM Code: Spastic entropion of right eye, unspecified eyelid

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H02.043

Is H02.043 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H02.043 in the Interactive Encoder