Question 1

What is ICD-10 code H05.253?

Accepted Answer

H05.253 is the ICD-10-CM diagnosis code for intermittent exophthalmos, bilateral. This condition involves the eyes bulging outward intermittently (coming and going) on both sides of the face. It typically occurs when there is increased pressure or swelling behind both eyeballs that is not constant. H05.253 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).

H05.253 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 that exophthalmos is documented as bilateral (affecting both eyes) and intermittent in nature before assigning this code.

Question 2

Is H05.253 an HCC code?

Accepted Answer

No. H05.253 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 H05.253 billable?

Accepted Answer

Yes. H05.253 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. H05.253 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 H05.253?

Accepted Answer

H05.253 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 H05.253 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 H05.253?

Accepted Answer

Verify that exophthalmos is documented as bilateral (affecting both eyes) and intermittent in nature before assigning this code Investigate and code the underlying cause if documented (such as thyroid eye disease, orbital inflammation, or vascular malformations), as this code describes the symptom rather than the etiology

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H05.253

Is H05.253 an HCC code?

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H05.253 ICD-10-CM Code: Intermittent exophthalmos, bilateral

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H05.253

Is H05.253 an HCC code?

What This Code Means

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Child Codes

Code Hierarchy

Open H05.253 in the Interactive Encoder