H02.224 ICD-10-CM Code: Mechanical lagophthalmos left upper 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)
H02.224
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMechanical lagophthalmos left upper eyelid
This condition occurs when the left upper eyelid cannot close completely due to mechanical problems, such as scarring, muscle weakness, or structural abnormalities, leaving part of the eye exposed. This can lead to dryness and irritation of the eye surface.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H02.224 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H02.224 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H02.224 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H02.224 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H02.224 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H02.224 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H02.224 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H02.224 an HCC code?
No. H02.224 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H02.224 is the ICD-10-CM diagnosis code for mechanical lagophthalmos left upper eyelid. This condition occurs when the left upper eyelid cannot close completely due to mechanical problems, such as scarring, muscle weakness, or structural abnormalities, leaving part of the eye exposed. This can lead to dryness and irritation of the eye surface. H02.224 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).
H02.224 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.
Verify laterality is documented as left upper eyelid; if bilateral or affecting both upper and lower lids, use separate codes for each affected eyelid.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.224 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify laterality is documented as left upper eyelid; if bilateral or affecting both upper and lower lids, use separate codes for each affected eyelid
- •Identify the underlying cause (e.g., post-surgical scarring, facial nerve paralysis, eyelid retraction) as it may require an additional code to fully describe the condition