Question 1

What is ICD-10 code H16.201?

Accepted Answer

H16.201 is the ICD-10-CM diagnosis code for unspecified keratoconjunctivitis, right eye. Inflammation of both the cornea and the conjunctiva (the membrane covering the white part of the eye) of the right eye, without a specified underlying cause. H16.201 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).

H16.201 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 non-specific code; if a specific cause is identified (viral, bacterial, allergic, etc.), use a more specific keratoconjunctivitis code.

Question 2

Is H16.201 an HCC code?

Accepted Answer

No. H16.201 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 H16.201 billable?

Accepted Answer

Yes. H16.201 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. H16.201 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 H16.201?

Accepted Answer

H16.201 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 H16.201 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 H16.201?

Accepted Answer

This is a non-specific code; if a specific cause is identified (viral, bacterial, allergic, etc.), use a more specific keratoconjunctivitis code Document any associated symptoms, discharge characteristics, and whether this is acute or chronic to support appropriate coding

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H16.201

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H16.201 ICD-10-CM Code: Unspecified keratoconjunctivitis, right eye

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H16.201

Is H16.201 an HCC code?

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Open H16.201 in the Interactive Encoder