H02.216 ICD-10-CM Code: Cicatricial lagophthalmos left eye, unspecified eyelid
H02.216 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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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)
H02.216
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCicatricial lagophthalmos left eye, unspecified eyelid
Scarring of the left eye causing inability to close completely, but the specific eyelid (upper or lower) is not specified.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for H02.216. Check the code and parent instructions in the Code Book.
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59, H00-H05
- certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59, H00-H05
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59, H00-H05
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59, H00-H05
- diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59, H00-H05
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59, H00-H05
- injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59, H00-H05
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59, H00-H05
- neoplasms (C00-D49)Inherited from H00-H59, H00-H05
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59, H00-H05
- syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59, H00-H05
- open wound of eyelid (S01.1-)Inherited from H00-H59, H00-H05
- superficial injury of eyelid (S00.1-, S00.2-)Inherited from H00-H59, H00-H05
Related Codes
Includes
OfficialNo Includes notes are included in this display for H02.216. Check the code and parent instructions in the Code Book.
Excludes 1
Official- congenital malformations of eyelid (Q10.0-Q10.3)Inherited from H02
Code First
OfficialNo Code First sequencing instructions are included in this display for H02.216. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for H02.216. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for H02.216. Check the code and parent instructions in the Code Book.
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 H02.216 an HCC code?
No. H02.216 is a billable ICD-10-CM code with no mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models.
- Code
- H02.216
- Description
- Cicatricial lagophthalmos left eye, unspecified eyelid
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- 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
H02.216 is the ICD-10-CM diagnosis code for cicatricial lagophthalmos left eye, unspecified eyelid. Scarring of the left eye causing inability to close completely, but the specific eyelid (upper or lower) is not specified. H02.216 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).
H02.216 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.
Use this code only when laterality is documented as left but eyelid specificity is unclear.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H02.216 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when laterality is documented as left but eyelid specificity is unclear
- •Request clarification from the provider if possible to assign a more specific code