Question 1

What is ICD-10 code H15.052?

Accepted Answer

H15.052 is the ICD-10-CM diagnosis code for scleromalacia perforans, left eye. Softening and thinning of the white part of the left eye, a severe condition that can lead to eye perforation and vision loss. H15.052 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).

H15.052 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.

This is a serious complication indicating advanced scleritis; verify documentation confirms scleromalacia perforans diagnosis.

Question 2

Is H15.052 an HCC code?

Accepted Answer

No. H15.052 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 H15.052 billable?

Accepted Answer

Yes. H15.052 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. H15.052 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 H15.052?

Accepted Answer

H15.052 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 H15.052 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 H15.052?

Accepted Answer

This is a serious complication indicating advanced scleritis; verify documentation confirms scleromalacia perforans diagnosis Often associated with rheumatoid arthritis or other systemic autoimmune diseases; review for related diagnoses

HCC Buddy Code Card

H15.052

Is H15.052 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H15.052 in HCC Buddy

H15.052 ICD-10-CM Code: Scleromalacia perforans, left eye

HCC Buddy Code Card

H15.052

Is H15.052 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H15.052 in HCC Buddy