H21.562 ICD-10-CM Code: Pupillary abnormality, 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)
H21.562
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePupillary abnormality, left eye
The pupil (the dark center part of the eye) in the left eye is not functioning or appearing normally, which can affect how light enters the eye and how well vision works. This could involve the pupil being an unusual size, shape, or not responding properly to light.
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
Code Trumping
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Code Book Path
Inclusion Terms
Official- Deformed pupil
- Ectopic pupil
- Rupture of sphincter, pupil
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H21.562 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H21.562 in this effective period.
Excludes 1
Official- congenital deformity of pupil (Q13.2-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H21.562 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H21.562 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H21.562 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 H21.562 an HCC code?
No. H21.562 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
H21.562 is the ICD-10-CM diagnosis code for pupillary abnormality, left eye. The pupil (the dark center part of the eye) in the left eye is not functioning or appearing normally, which can affect how light enters the eye and how well vision works. This could involve the pupil being an unusual size, shape, or not responding properly to light. H21.562 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).
H21.562 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.
Verify documentation specifies the left eye (H21.562) versus right eye (H21.561) or bilateral (H21.56) to ensure accurate laterality coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H21.562 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies the left eye (H21.562) versus right eye (H21.561) or bilateral (H21.56) to ensure accurate laterality coding
- •Review clinical notes to determine the specific type of pupillary abnormality (such as Adie's pupil, Argyll Robertson pupil, or other specified abnormalities) as more specific codes may be available under H21.56-