Question 1

What is ICD-10 code H16.239?

Accepted Answer

H16.239 is the ICD-10-CM diagnosis code for neurotrophic keratoconjunctivitis, unspecified eye. A condition where the cornea and conjunctiva become inflamed due to nerve damage, affecting an unspecified eye. This can lead to corneal ulcers and vision problems if untreated. H16.239 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).

H16.239 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.

Use this code only when the affected eye is not specified; if laterality is documented, use H16.231 (right) or H16.232 (left).

Question 2

Is H16.239 an HCC code?

Accepted Answer

No. H16.239 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 H16.239 billable?

Accepted Answer

Yes. H16.239 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. H16.239 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 H16.239?

Accepted Answer

H16.239 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 H16.239 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 H16.239?

Accepted Answer

Use this code only when the affected eye is not specified; if laterality is documented, use H16.231 (right) or H16.232 (left) This condition is often associated with diabetes, herpes zoster, or other neurological disorders; document the underlying cause if present

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H16.239

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H16.239 ICD-10-CM Code: Neurotrophic keratoconjunctivitis, unspecified eye

HCC Buddy Code Card

H16.239

Is H16.239 an HCC code?

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Open H16.239 in the Interactive Encoder