Question 1

What is ICD-10 code H11.023?

Accepted Answer

H11.023 is the ICD-10-CM diagnosis code for central pterygium of eye, bilateral. A growth of tissue on the white part of both eyes that extends toward the center, potentially affecting vision in both eyes. H11.023 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of conjunctiva (h10-h11).

H11.023 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 only when documentation explicitly confirms bilateral involvement.

Question 2

Is H11.023 an HCC code?

Accepted Answer

No. H11.023 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 H11.023 billable?

Accepted Answer

Yes. H11.023 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. H11.023 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 H11.023?

Accepted Answer

H11.023 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 community model rewards H11.023 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 5

What should coders know when reporting H11.023?

Accepted Answer

Use this code only when documentation explicitly confirms bilateral involvement Do not use this code if only one eye is affected; assign the appropriate unilateral code instead

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H11.023

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H11.023 ICD-10-CM Code: Central pterygium of eye, bilateral

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H11.023

Is H11.023 an HCC code?

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