H16.242 ICD-10-CM Code: Ophthalmia nodosa, left 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)
H16.242
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOphthalmia nodosa, left eye
A type of eye inflammation characterized by small nodular lesions on the conjunctiva, typically caused by irritation from foreign material or allergic reaction, affecting the left eye.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H16.242 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H16.242 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H16.242 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H16.242 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H16.242 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H16.242 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H16.242 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 H16.242 an HCC code?
No. H16.242 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
H16.242 is the ICD-10-CM diagnosis code for ophthalmia nodosa, left eye. A type of eye inflammation characterized by small nodular lesions on the conjunctiva, typically caused by irritation from foreign material or allergic reaction, affecting the left eye. H16.242 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).
H16.242 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.
Ophthalmia nodosa is often caused by caterpillar hairs or plant material; document the causative agent if known.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H16.242 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ophthalmia nodosa is often caused by caterpillar hairs or plant material; document the causative agent if known
- •Ensure laterality is correctly documented as left eye to avoid coding errors