Question 1

What is ICD-10 code H59.211?

Accepted Answer

H59.211 is the ICD-10-CM diagnosis code for Accidental puncture and laceration of right eye and adnexa during an ophthalmic procedure. An accidental cut or puncture wound to the right eye or surrounding tissues that occurs during eye surgery. H59.211 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H59.211 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Question 2

Is H59.211 an HCC code?

Accepted Answer

No. H59.211 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 H59.211 billable?

Accepted Answer

Yes. H59.211 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. H59.211 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 H59.211?

Accepted Answer

H59.211 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 H59.211 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 H59.211?

Accepted Answer

This represents an iatrogenic injury during an ophthalmic procedure; document the specific structure injured if possible Distinguish from intentional surgical incisions by confirming the injury was unintended

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H59.211

Is H59.211 an HCC code?

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