Question 1

What is ICD-10 code H40.043?

Accepted Answer

H40.043 is the ICD-10-CM diagnosis code for steroid responder, bilateral. A condition where eye pressure increases in response to steroid medication use in both eyes, which can lead to glaucoma if not monitored. H40.043 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering glaucoma (h40-h42).

H40.043 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.

Document which steroid medication caused the response and verify bilateral involvement before coding.

Question 2

Is H40.043 an HCC code?

Accepted Answer

No. H40.043 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 H40.043 billable?

Accepted Answer

Yes. H40.043 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. H40.043 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 H40.043?

Accepted Answer

H40.043 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 H40.043 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 H40.043?

Accepted Answer

Document which steroid medication caused the response and verify bilateral involvement before coding Link this code to the steroid medication being used (typically topical or systemic steroids)

H40.043

Is H40.043 an HCC code?

What This Code Means

Coding Tips

Code Hierarchy

Open H40.043 in the Interactive Encoder