Question 1

What is ICD-10 code H16.333?

Accepted Answer

H16.333 is the ICD-10-CM diagnosis code for Sclerosing keratitis, bilateral. This condition involves inflammation and scarring of the clear front part of the eye (cornea) that affects both eyes. It can lead to vision problems if left untreated. H16.333 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H16.333 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.

Question 2

Is H16.333 an HCC code?

Accepted Answer

No. H16.333 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 H16.333 billable?

Accepted Answer

Yes. H16.333 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. H16.333 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 H16.333?

Accepted Answer

H16.333 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 H16.333 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 H16.333?

Accepted Answer

Verify that the condition is documented as affecting both eyes before assigning the bilateral code; if only one eye is affected, use H16.331 (right eye) or H16.332 (left eye) instead Sclerosing keratitis is often associated with systemic conditions like rheumatoid arthritis or granulomatosis with polyangiitis (GPA), so review the medical record for any underlying diagnoses that should be coded separately

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H16.333

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H16.333 ICD-10-CM Code: Sclerosing keratitis, bilateral

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H16.333

Is H16.333 an HCC code?

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Work H16.333 in HCC Buddy