Question 1

What is ICD-10 code H16.262?

Accepted Answer

H16.262 is the ICD-10-CM diagnosis code for vernal keratoconjunctivitis, with limbar and corneal involvement, left eye. A seasonal allergic inflammation of the cornea and conjunctiva with involvement of the limbus (border of the cornea) and corneal surface, affecting the left eye. It typically occurs in warm weather. H16.262 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).

H16.262 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.

Vernal keratoconjunctivitis is more common in children and young adults in warm climates; document seasonal pattern if present.

Question 2

Is H16.262 an HCC code?

Accepted Answer

No. H16.262 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 H16.262 billable?

Accepted Answer

Yes. H16.262 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. H16.262 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

Which HCC does H16.262 map to under V28?

Accepted Answer

H16.262 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does H16.262 pay in RAF?

Accepted Answer

H16.262 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for H16.262?

Accepted Answer

H16.262 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 H16.262 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 7

What documentation supports H16.262?

Accepted Answer

Vernal keratoconjunctivitis is more common in children and young adults in warm climates; document seasonal pattern if present Ensure left eye laterality is clearly documented; this code specifies limbal and corneal involvement H16.262 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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H16.262

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H16.262 ICD-10-CM Code: Vernal keratoconjunctivitis, with limbar and corneal involvement, left eye

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H16.262

Is H16.262 an HCC code?

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