Question 1

What is ICD-10 code H02.815?

Accepted Answer

H02.815 is the ICD-10-CM diagnosis code for retained foreign body in left lower eyelid. A foreign object that remains embedded in or on the left lower eyelid after initial injury or exposure. H02.815 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).

H02.815 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.

Confirm documentation specifies left lower eyelid to ensure correct code assignment.

Question 2

Is H02.815 an HCC code?

Accepted Answer

No. H02.815 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 H02.815 billable?

Accepted Answer

Yes. H02.815 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. H02.815 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 H02.815?

Accepted Answer

H02.815 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 H02.815 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 H02.815?

Accepted Answer

Confirm documentation specifies left lower eyelid to ensure correct code assignment Note any associated symptoms such as irritation, infection, or vision impairment in the clinical record

HCC Buddy Code Card

H02.815

Is H02.815 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H02.815 in HCC Buddy

H02.815 ICD-10-CM Code: Retained foreign body in left lower eyelid

HCC Buddy Code Card

H02.815

Is H02.815 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H02.815 in HCC Buddy