Question 1

What is ICD-10 code H15.009?

Accepted Answer

H15.009 is the ICD-10-CM diagnosis code for unspecified scleritis, unspecified eye. Scleritis is inflammation of the sclera, which is the white outer layer of the eye. This code is used when the exact type of scleritis is not specified and the affected eye is not documented. H15.009 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of sclera, cornea, iris and ciliary body (h15-h22).

H15.009 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.

Query the provider if the eye laterality (right, left, or bilateral) is documented elsewhere in the medical record, as this would allow for a more specific code assignment.

Question 2

Is H15.009 an HCC code?

Accepted Answer

No. H15.009 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 H15.009 billable?

Accepted Answer

Yes. H15.009 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. H15.009 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 H15.009?

Accepted Answer

H15.009 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 H15.009 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 H15.009?

Accepted Answer

Query the provider if the eye laterality (right, left, or bilateral) is documented elsewhere in the medical record, as this would allow for a more specific code assignment If the type of scleritis is documented (such as anterior, posterior, or diffuse), use the appropriate H15.0 subcategory code instead of the unspecified code

HCC Buddy Code Card

H15.009

Is H15.009 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H15.009 in HCC Buddy

H15.009 ICD-10-CM Code: Unspecified scleritis, unspecified eye

HCC Buddy Code Card

H15.009

Is H15.009 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H15.009 in HCC Buddy