What is ICD-10 code H16.219?

H16.219 is the ICD-10-CM diagnosis code for Exposure keratoconjunctivitis, unspecified eye. It belongs to the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59). H16.219 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H16.219 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. H16.219 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. H16.219 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.

Which HCC does H16.219 map to under V28?

H16.219 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

What RAF reference is published for H16.219?

H16.219 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

What is the V28 vs V24 difference for H16.219?

H16.219 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

2026 ICD-10-CM H16.219: Exposure keratoconjunctivitis

H16.219 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupH16.219

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of sclera, cornea, iris and ciliary body (H15-H22)

H16.219

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Exposure keratoconjunctivitis, unspecified eye

This condition occurs when the eye's surface becomes inflamed and irritated due to inadequate eyelid closure or excessive eye exposure, causing dryness and discomfort. It typically affects one or both eyes when the eyelids cannot fully protect the cornea and conjunctiva.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

H16.2Keratoconjunctivitis H16.21Exposure keratoconjunctivitis H16.219Exposure keratoconjunctivitis, unspecified eye

Inclusion Terms

Official

No inclusion terms are included in this display for H16.219. Check the code and parent instructions in the Code Book.

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59
certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59
diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59
injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59
neoplasms (C00-D49)Inherited from H00-H59
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59
syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59

Related Codes

Official

H16.211Exposure keratoconjunctivitis, right eye H16.212Exposure keratoconjunctivitis, left eye H16.213Exposure keratoconjunctivitis, bilateral

Includes

Official

No Includes notes are included in this display for H16.219. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for H16.219. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for H16.219. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for H16.219. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for H16.219. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Use the 5th character to specify laterality: H16.211 (right eye), H16.212 (left eye), H16.213 (bilateral), or H16.219 (unspecified eye) when the documentation does not clearly indicate which eye is affected

This code is appropriate when the underlying cause of exposure (such as Bell's palsy, thyroid eye disease, or eyelid surgery) is not documented; if a specific cause is identified, consider coding the underlying condition as well

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is H16.219 an HCC code?

No. H16.219 is a billable ICD-10-CM code with no mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: H16.219
Description: Exposure keratoconjunctivitis, unspecified eye
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

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

H16.219 is the ICD-10-CM diagnosis code for exposure keratoconjunctivitis, unspecified eye. This condition occurs when the eye's surface becomes inflamed and irritated due to inadequate eyelid closure or excessive eye exposure, causing dryness and discomfort. It typically affects one or both eyes when the eyelids cannot fully protect the cornea and conjunctiva. H16.219 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).

H16.219 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H16.219 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use the 5th character to specify laterality: H16.211 (right eye), H16.212 (left eye), H16.213 (bilateral), or H16.219 (unspecified eye) when the documentation does not clearly indicate which eye is affected
•This code is appropriate when the underlying cause of exposure (such as Bell's palsy, thyroid eye disease, or eyelid surgery) is not documented; if a specific cause is identified, consider coding the underlying condition as well