Question 1

What is ICD-10 code H22?

Accepted Answer

H22 is the ICD-10-CM diagnosis code for disorders of iris and ciliary body in diseases classified elsewhere. Problems with the iris or ciliary body that occur as a result of another disease or condition classified elsewhere in the ICD-10 system. H22 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).

H22 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.

This code requires a secondary diagnosis code to identify the underlying disease causing the iris or ciliary body disorder.

Question 2

Is H22 an HCC code?

Accepted Answer

No. H22 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 H22 billable?

Accepted Answer

Yes. H22 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. H22 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 H22?

Accepted Answer

H22 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 H22 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 5

What should coders know when reporting H22?

Accepted Answer

This code requires a secondary diagnosis code to identify the underlying disease causing the iris or ciliary body disorder Always code the primary condition first, then use H22 as a secondary code to indicate the ocular manifestation

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H22

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H22 ICD-10-CM Code: Disorders of iris and ciliary body in diseases classified elsewhere

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H22

Is H22 an HCC code?

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Work H22 in HCC Buddy