Question 1

What is ICD-10 code H02.402?

Accepted Answer

H02.402 is the ICD-10-CM diagnosis code for unspecified ptosis of left eyelid. Drooping of the left eyelid due to an unspecified cause, which may affect vision or appearance. H02.402 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).

H02.402 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 before assigning this code.

Question 2

Is H02.402 an HCC code?

Accepted Answer

No. H02.402 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 H02.402 billable?

Accepted Answer

Yes. H02.402 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. H02.402 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 H02.402?

Accepted Answer

H02.402 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 H02.402 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 H02.402?

Accepted Answer

Verify laterality is documented as left before assigning this code If the etiology becomes known during the encounter, consider updating to a more specific ptosis code

HCC Buddy Code Card

H02.402

Is H02.402 an HCC code?

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Open H02.402 in the Interactive Encoder

H02.402 ICD-10-CM Code: Unspecified ptosis of left eyelid

HCC Buddy Code Card

H02.402

Is H02.402 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H02.402 in the Interactive Encoder