Question 1

What is ICD-10 code H59.219?

Accepted Answer

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

Question 2

Is H59.219 an HCC code?

Accepted Answer

No. H59.219 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 H59.219 billable?

Accepted Answer

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.

Question 4

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

Accepted Answer

H59.219 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 H59.219 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 H59.219?

Accepted Answer

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

HCC Buddy Code Card

H59.219

Is H59.219 an HCC code?

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Open H59.219 in the Interactive Encoder

H59.219 ICD-10-CM Code: Accidental puncture and laceration of unspecified eye and adnexa during an ophthalmic procedure

HCC Buddy Code Card

H59.219

Is H59.219 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H59.219 in the Interactive Encoder