Question 1

What is ICD-10 code H26.059?

Accepted Answer

H26.059 is the ICD-10-CM diagnosis code for posterior subcapsular polar infantile and juvenile cataract, unspecified eye. A clouding of the lens that develops in childhood, located in the back layer just under the lens capsule, but the specific eye affected is not documented. H26.059 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of lens (h25-h28).

H26.059 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 is a default code used when laterality cannot be determined from documentation.

Question 2

Is H26.059 an HCC code?

Accepted Answer

No. H26.059 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 H26.059 billable?

Accepted Answer

Yes. H26.059 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. H26.059 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 H26.059?

Accepted Answer

H26.059 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 H26.059 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 H26.059?

Accepted Answer

This is a default code used when laterality cannot be determined from documentation Query the provider to clarify which eye(s) are affected to assign a more specific code

HCC Buddy Code Card

H26.059

Is H26.059 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H26.059 in HCC Buddy

H26.059 ICD-10-CM Code: Posterior subcapsular polar infantile and juvenile cataract, unspecified eye

HCC Buddy Code Card

H26.059

Is H26.059 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work H26.059 in HCC Buddy