Question 1

What is ICD-10 code H02.145?

Accepted Answer

H02.145 is the ICD-10-CM diagnosis code for spastic ectropion of left lower eyelid. The left lower eyelid turns outward due to muscle spasms, exposing the inner eyelid surface. H02.145 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).

H02.145 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.

Distinguish between spastic ectropion (involuntary muscle contraction) and mechanical ectropion (structural changes).

Question 2

Is H02.145 an HCC code?

Accepted Answer

No. H02.145 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 H02.145 billable?

Accepted Answer

Yes. H02.145 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. H02.145 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 H02.145?

Accepted Answer

H02.145 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 H02.145 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 H02.145?

Accepted Answer

Distinguish between spastic ectropion (involuntary muscle contraction) and mechanical ectropion (structural changes) Note any associated symptoms such as eye irritation, tearing, or corneal exposure

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H02.145

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H02.145 ICD-10-CM Code: Spastic ectropion of left lower eyelid

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H02.145

Is H02.145 an HCC code?

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