H57.09 ICD-10-CM Code: Other anomalies of pupillary function
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Other disorders of eye and adnexa (H55-H57)
H57.09
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther anomalies of pupillary function
This code describes unusual or abnormal functioning of the pupil (the black circle in the center of the eye) that doesn't fit into other specific categories. The pupil normally changes size in response to light and focus, so this code is used when there are other types of pupil problems beyond the more common ones.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H57.09 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H57.09 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H57.09 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H57.09 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H57.09 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H57.09 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H57.09 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H57.09 an HCC code?
No. H57.09 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
Get the V28 RAF + MEAT cheat sheet
One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.
Free PDF. No card. Unsubscribe anytime.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H57.09 is the ICD-10-CM diagnosis code for other anomalies of pupillary function. This code describes unusual or abnormal functioning of the pupil (the black circle in the center of the eye) that doesn't fit into other specific categories. The pupil normally changes size in response to light and focus, so this code is used when there are other types of pupil problems beyond the more common ones. H57.09 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering other disorders of eye and adnexa (h55-h57).
H57.09 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 this code only when the pupillary anomaly doesn't fit into more specific codes like Adie's syndrome (H57.01) or Argyll Robertson pupils (H57.02).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H57.09 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the pupillary anomaly doesn't fit into more specific codes like Adie's syndrome (H57.01) or Argyll Robertson pupils (H57.02)
- •Ensure documentation clearly describes the specific pupillary function abnormality observed during examination, and specify laterality (right eye, left eye, or bilateral) when applicable