H16.059 ICD-10-CM Code: Mooren's corneal ulcer, unspecified eye
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of sclera, cornea, iris and ciliary body (H15-H22)
H16.059
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMooren's corneal ulcer, unspecified eye
Mooren's corneal ulcer is a rare, progressive inflammatory condition that causes a painful ulcer (open sore) on the clear front surface of the eye. This code is used when the specific eye affected is not documented.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H16.059 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H16.059 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H16.059 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H16.059 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H16.059 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H16.059 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H16.059 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H16.059 an HCC code?
No. H16.059 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H16.059 is the ICD-10-CM diagnosis code for mooren's corneal ulcer, unspecified eye. Mooren's corneal ulcer is a rare, progressive inflammatory condition that causes a painful ulcer (open sore) on the clear front surface of the eye. This code is used when the specific eye affected is not documented. H16.059 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).
H16.059 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.
Always attempt to determine laterality (right eye H16.051, left eye H16.052, or bilateral H16.053) before defaulting to unspecified code H16.059, as specificity improves coding accuracy.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H16.059 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always attempt to determine laterality (right eye H16.051, left eye H16.052, or bilateral H16.053) before defaulting to unspecified code H16.059, as specificity improves coding accuracy
- •Mooren's ulcer is often associated with autoimmune conditions; review documentation for any systemic disease associations that may require additional coding