H02.159 ICD-10-CM Code: Paralytic ectropion of unspecified eye, unspecified eyelid
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of eyelid, lacrimal system and orbit (H00-H05)
H02.159
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceParalytic ectropion of unspecified eye, unspecified eyelid
Weakness or paralysis of the eyelid muscles of an unspecified eye, causing the eyelid to turn outward and fail to close properly.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H02.159 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H02.159 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H02.159 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H02.159 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H02.159 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H02.159 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H02.159 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is H02.159 an HCC code?
No. H02.159 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- H02.159
- Description
- Paralytic ectropion of unspecified eye, unspecified eyelid
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H02.159 is the ICD-10-CM diagnosis code for paralytic ectropion of unspecified eye, unspecified eyelid. Weakness or paralysis of the eyelid muscles of an unspecified eye, causing the eyelid to turn outward and fail to close properly. H02.159 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).
H02.159 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 is a less specific code; use only when the affected eye cannot be determined from documentation.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.159 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a less specific code; use only when the affected eye cannot be determined from documentation
- •Query the provider if laterality (left vs. right eye) is not documented to allow for more specific code assignment