Question 1

What is ICD-10 code H20.052?

Accepted Answer

H20.052 is the ICD-10-CM diagnosis code for hypopyon, left eye. A collection of pus in the front part of the eye (iris and ciliary body area) in the left eye, typically appearing as a white or yellowish layer at the bottom of the iris. H20.052 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).

H20.052 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.

Hypopyon is a clinical finding that indicates inflammation; verify the laterality is specifically documented as left eye.

Question 2

Is H20.052 an HCC code?

Accepted Answer

No. H20.052 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 H20.052 billable?

Accepted Answer

Yes. H20.052 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. H20.052 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 H20.052?

Accepted Answer

H20.052 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 H20.052 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 H20.052?

Accepted Answer

Hypopyon is a clinical finding that indicates inflammation; verify the laterality is specifically documented as left eye This code should be used with a primary diagnosis code for the underlying cause of iridocyclitis

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H20.052

Is H20.052 an HCC code?

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H20.052 ICD-10-CM Code: Hypopyon, left eye

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H20.052

Is H20.052 an HCC code?

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Child Codes

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Open H20.052 in the Interactive Encoder