H02.854 ICD-10-CM Code: Elephantiasis of left upper eyelid
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of eyelid, lacrimal system and orbit (H00-H05)
H02.854
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceElephantiasis of left upper eyelid
Severe swelling and thickening of the left upper eyelid caused by fluid accumulation, often resulting from lymphatic obstruction or chronic inflammation. This condition makes the eyelid appear enlarged and heavy, similar to elephant skin.
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
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H02.854 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H02.854 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H02.854 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H02.854 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H02.854 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H02.854 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H02.854 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 H02.854 an HCC code?
No. H02.854 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
H02.854 is the ICD-10-CM diagnosis code for elephantiasis of left upper eyelid. Severe swelling and thickening of the left upper eyelid caused by fluid accumulation, often resulting from lymphatic obstruction or chronic inflammation. This condition makes the eyelid appear enlarged and heavy, similar to elephant skin. H02.854 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).
H02.854 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 (H02.854) versus right (H02.853) or bilateral (H02.85A) to ensure accurate code selection.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H02.854 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 (H02.854) versus right (H02.853) or bilateral (H02.85A) to ensure accurate code selection
- •Investigate and document the underlying cause (lymphatic obstruction, infection, malignancy, or chronic inflammation) as this may require additional coding and affects treatment planning