Question 1

What is ICD-10 code H02.103?

Accepted Answer

H02.103 is the ICD-10-CM diagnosis code for Unspecified ectropion of right eye, unspecified eyelid. It belongs to the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59). H02.103 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H02.103 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 H02.103 an HCC code?

Accepted Answer

No. H02.103 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 H02.103 billable?

Accepted Answer

Yes. H02.103 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. H02.103 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

Which HCC does H02.103 map to under V28?

Accepted Answer

H02.103 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does H02.103 pay in RAF?

Accepted Answer

H02.103 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for H02.103?

Accepted Answer

H02.103 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 community model rewards H02.103 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 7

What documentation supports H02.103?

Accepted Answer

Query the provider if the specific eyelid (upper H02.101 or lower H02.102) can be determined, as this provides more precise documentation Ectropion codes require laterality (right/left) and eyelid specification; if documentation is truly unspecified, H02.103 is appropriate, but attempt clarification first H02.103 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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H02.103

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H02.103 ICD-10-CM Code: Unspecified ectropion of right eye, unspecified eyelid

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H02.103

Is H02.103 an HCC code?

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What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H02.103 in HCC Buddy