Question 1

What is ICD-10 code H02.831?

Accepted Answer

H02.831 is the ICD-10-CM diagnosis code for dermatochalasis of right upper eyelid. Excess or sagging skin on the upper eyelid of the right eye, which may cause drooping and affect vision or appearance. H02.831 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).

H02.831 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.

Dermatochalasis is different from ptosis; ensure correct diagnosis is documented.

Question 2

Is H02.831 an HCC code?

Accepted Answer

No. H02.831 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 H02.831 billable?

Accepted Answer

Yes. H02.831 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. H02.831 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 H02.831?

Accepted Answer

H02.831 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 H02.831 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 H02.831?

Accepted Answer

Dermatochalasis is different from ptosis; ensure correct diagnosis is documented Document whether the condition is causing functional impairment or is purely cosmetic

HCC Buddy Code Card

H02.831

Is H02.831 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H02.831 in the Interactive Encoder

H02.831 ICD-10-CM Code: Dermatochalasis of right upper eyelid

HCC Buddy Code Card

H02.831

Is H02.831 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H02.831 in the Interactive Encoder