Question 1

What is ICD-10 code H15.032?

Accepted Answer

H15.032 is the ICD-10-CM diagnosis code for posterior scleritis, left eye. Posterior scleritis is inflammation of the back part of the white of the eye (sclera) on the left side. This condition can cause eye pain, vision problems, and swelling in the tissues behind the eye. H15.032 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).

H15.032 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.

Ensure laterality is documented in the medical record as 'left eye' to support the fifth character '2' in this code.

Question 2

Is H15.032 an HCC code?

Accepted Answer

No. H15.032 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 H15.032 billable?

Accepted Answer

Yes. H15.032 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. H15.032 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 H15.032?

Accepted Answer

H15.032 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 H15.032 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 H15.032?

Accepted Answer

Ensure laterality is documented in the medical record as 'left eye' to support the fifth character '2' in this code Verify whether this is initial episode or recurrent/chronic presentation, as this may affect documentation and treatment planning; confirm if both eyes are affected as separate codes would be needed for bilateral cases

H15.032

Is H15.032 an HCC code?

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