What is ICD-10 code H59.219?

H59.219 is the ICD-10-CM diagnosis code for Accidental puncture and laceration of unspecified eye and adnexa during an ophthalmic procedure. An accidental cut or puncture wound to an eye or surrounding tissues during eye surgery when the specific eye is not documented. H59.219 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H59.219 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.

Yes. H59.219 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. H59.219 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.

Which HCC does H59.219 map to under V28?

H59.219 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

What RAF reference is published for H59.219?

H59.219 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

What is the V28 vs V24 difference for H59.219?

H59.219 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

What documentation supports H59.219?

Use only when the affected eye cannot be determined from the operative report Request clarification from the surgeon regarding which eye sustained the accidental injury H59.219 is not a CMS-HCC V28 payment code in the verified current source, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

2026 ICD-10-CM H59.219: Accidental puncture and laceration

H59.219 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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Code lookupH59.219

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified (H59)

H59.219

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Accidental puncture and laceration of unspecified eye and adnexa during an ophthalmic procedure

An accidental cut or puncture wound to an eye or surrounding tissues during eye surgery when the specific eye is not documented.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

H59.2Accidental puncture and laceration of eye and adnexa during a procedure H59.21Accidental puncture and laceration of eye and adnexa during an ophthalmic procedure H59.219Accidental puncture and laceration of unspecified eye and adnexa during an ophthalmic procedure

Inclusion Terms

Official

No inclusion terms are included in this display for H59.219. Check the code and parent instructions in the Code Book.

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59
certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59
diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59
injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59
neoplasms (C00-D49)Inherited from H00-H59
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59
syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59

Related Codes

Official

H59.211Accidental puncture and laceration of right eye and adnexa during an ophthalmic procedure H59.212Accidental puncture and laceration of left eye and adnexa during an ophthalmic procedure H59.213Accidental puncture and laceration of eye and adnexa during an ophthalmic procedure, bilateral

Includes

Official

No Includes notes are included in this display for H59.219. Check the code and parent instructions in the Code Book.

Excludes 1

Official

mechanical complication of intraocular lens (T85.2)Inherited from H59
mechanical complication of other ocular prosthetic devices, implants and grafts (T85.3)Inherited from H59
pseudophakia (Z96.1)Inherited from H59
secondary cataracts (H26.4-)Inherited from H59

Code First

Official

No Code First sequencing instructions are included in this display for H59.219. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for H59.219. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for H59.219. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Use only when the affected eye cannot be determined from the operative report

Request clarification from the surgeon regarding which eye sustained the accidental injury

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is H59.219 an HCC code?

No. H59.219 is a billable ICD-10-CM code with no mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: H59.219
Description: Accidental puncture and laceration of unspecified eye and adnexa during an ophthalmic procedure
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).

What This Code Means

H59.219 is the ICD-10-CM diagnosis code for accidental puncture and laceration of unspecified eye and adnexa during an ophthalmic procedure. An accidental cut or puncture wound to an eye or surrounding tissues during eye surgery when the specific eye is not documented. H59.219 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified (h59).

H59.219 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Use only when the affected eye cannot be determined from the operative report.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H59.219 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use only when the affected eye cannot be determined from the operative report
•Request clarification from the surgeon regarding which eye sustained the accidental injury