Question 1

What is ICD-10 code H16.041?

Accepted Answer

H16.041 is the ICD-10-CM diagnosis code for marginal corneal ulcer, right eye. An ulcer located at the edge or margin of the cornea in the right eye, which can develop from inflammation or infection. H16.041 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).

H16.041 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.

Marginal ulcers are often associated with systemic autoimmune diseases; review for related conditions to code.

Question 2

Is H16.041 an HCC code?

Accepted Answer

No. H16.041 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 H16.041 billable?

Accepted Answer

Yes. H16.041 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. H16.041 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 H16.041?

Accepted Answer

H16.041 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 H16.041 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 H16.041?

Accepted Answer

Marginal ulcers are often associated with systemic autoimmune diseases; review for related conditions to code Verify right eye laterality is clearly documented in the medical record

HCC Buddy Code Card

H16.041

Is H16.041 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H16.041 in the Interactive Encoder

H16.041 ICD-10-CM Code: Marginal corneal ulcer, right eye

HCC Buddy Code Card

H16.041

Is H16.041 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H16.041 in the Interactive Encoder