Question 1

What is ICD-10 code H02.116?

Accepted Answer

H02.116 is the ICD-10-CM diagnosis code for cicatricial ectropion of left eye, unspecified eyelid. Scarring or contracture of tissue has caused an eyelid on the left eye to turn outward, but the specific eyelid (upper or lower) is not specified. H02.116 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).

H02.116 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.

This code indicates left eye involvement but unspecified eyelid location.

Question 2

Is H02.116 an HCC code?

Accepted Answer

No. H02.116 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 H02.116 billable?

Accepted Answer

Yes. H02.116 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. H02.116 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 H02.116?

Accepted Answer

H02.116 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 H02.116 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 H02.116?

Accepted Answer

This code indicates left eye involvement but unspecified eyelid location Query provider for clarification on whether upper or lower eyelid is affected

H02.116

Is H02.116 an HCC code?

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Open H02.116 in the Interactive Encoder