Question 1

What is ICD-10 code H02.843?

Accepted Answer

H02.843 is the ICD-10-CM diagnosis code for edema of right eye, unspecified eyelid. Swelling or puffiness of the right eyelid when the specific upper or lower location is not specified. H02.843 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).

H02.843 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.

Use this code when documentation indicates right eye edema but doesn't specify upper or lower lid.

Question 2

Is H02.843 an HCC code?

Accepted Answer

No. H02.843 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 H02.843 billable?

Accepted Answer

Yes. H02.843 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. H02.843 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 H02.843?

Accepted Answer

H02.843 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 H02.843 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 H02.843?

Accepted Answer

Use this code when documentation indicates right eye edema but doesn't specify upper or lower lid Query for clarification on eyelid location to allow for more specific coding

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H02.843

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H02.843 ICD-10-CM Code: Edema of right eye, unspecified eyelid

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H02.843

Is H02.843 an HCC code?

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Work H02.843 in HCC Buddy