Question 1

What is ICD-10 code H16.103?

Accepted Answer

H16.103 is the ICD-10-CM diagnosis code for unspecified superficial keratitis, bilateral. Inflammation of the outer layer of the cornea affecting both eyes, without a specified underlying cause. H16.103 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).

H16.103 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.

Bilateral coding indicates both eyes are affected; ensure documentation supports bilateral involvement.

Question 2

Is H16.103 an HCC code?

Accepted Answer

No. H16.103 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 H16.103 billable?

Accepted Answer

Yes. H16.103 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. H16.103 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 H16.103?

Accepted Answer

H16.103 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 community model rewards H16.103 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 5

What should coders know when reporting H16.103?

Accepted Answer

Bilateral coding indicates both eyes are affected; ensure documentation supports bilateral involvement If only one eye is affected, use the appropriate unilateral code instead

HCC Buddy Code Card

H16.103

Is H16.103 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H16.103 in HCC Buddy

H16.103 ICD-10-CM Code: Unspecified superficial keratitis, bilateral

HCC Buddy Code Card

H16.103

Is H16.103 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H16.103 in HCC Buddy