Question 1

What is ICD-10 code H47.092?

Accepted Answer

H47.092 is the ICD-10-CM diagnosis code for other disorders of optic nerve, not elsewhere classified, left eye. Other unspecified disorders or conditions affecting the optic nerve in the left eye that are not classified elsewhere. H47.092 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of optic nerve and visual pathways (h46-h47).

H47.092 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 catch-all code; document the specific nature of the optic nerve disorder as clearly as possible in the medical record.

Question 2

Is H47.092 an HCC code?

Accepted Answer

No. H47.092 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 H47.092 billable?

Accepted Answer

Yes. H47.092 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. H47.092 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 H47.092?

Accepted Answer

H47.092 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 H47.092 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 H47.092?

Accepted Answer

This is a catch-all code; document the specific nature of the optic nerve disorder as clearly as possible in the medical record Review documentation to determine if a more specific code exists; use this code only when no other H47 code accurately describes the condition

HCC Buddy Code Card

H47.092

Is H47.092 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H47.092 in the Interactive Encoder

H47.092 ICD-10-CM Code: Other disorders of optic nerve, not elsewhere classified, left eye

HCC Buddy Code Card

H47.092

Is H47.092 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H47.092 in the Interactive Encoder