Question 1

What is ICD-10 code H40.023?

Accepted Answer

H40.023 is the ICD-10-CM diagnosis code for open angle with borderline findings, high risk, bilateral. A condition where both eyes have open drainage angles but show borderline signs of glaucoma with high risk of vision loss. H40.023 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).

H40.023 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.

Use bilateral code only when both eyes are documented as having high-risk borderline findings.

Question 2

Is H40.023 an HCC code?

Accepted Answer

No. H40.023 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 H40.023 billable?

Accepted Answer

Yes. H40.023 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. H40.023 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 H40.023?

Accepted Answer

H40.023 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 H40.023 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 H40.023?

Accepted Answer

Use bilateral code only when both eyes are documented as having high-risk borderline findings Do not use this code if only one eye is affected; use the appropriate unilateral code instead

HCC Buddy Code Card

H40.023

Is H40.023 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H40.023 in the Interactive Encoder

H40.023 ICD-10-CM Code: Open angle with borderline findings, high risk, bilateral

HCC Buddy Code Card

H40.023

Is H40.023 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H40.023 in the Interactive Encoder