Question 1

What is ICD-10 code H02.133?

Accepted Answer

H02.133 is the ICD-10-CM diagnosis code for senile ectropion of right eye, unspecified eyelid. The right eyelid is turning outward due to age-related degeneration of eyelid tissues, but the specific eyelid (upper or lower) is not specified in the documentation. H02.133 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).

H02.133 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.

Query the provider if possible to determine whether the upper or lower eyelid is affected for more specific coding.

Question 2

Is H02.133 an HCC code?

Accepted Answer

No. H02.133 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 H02.133 billable?

Accepted Answer

Yes. H02.133 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. H02.133 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 H02.133?

Accepted Answer

H02.133 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 H02.133 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 H02.133?

Accepted Answer

Query the provider if possible to determine whether the upper or lower eyelid is affected for more specific coding Use this code only when the eyelid location cannot be determined from available documentation

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H02.133

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H02.133 ICD-10-CM Code: Senile ectropion of right eye, unspecified eyelid

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H02.133

Is H02.133 an HCC code?

What This Code Means

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Child Codes

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Work H02.133 in HCC Buddy