Question 1

What is ICD-10 code H60.531?

Accepted Answer

H60.531 is the ICD-10-CM diagnosis code for acute contact otitis externa, right ear. A sudden inflammation of the outer ear canal on the right ear caused by direct contact with an irritating substance or allergen. H60.531 sits in the ICD-10-CM chapter for diseases of the ear and mastoid process (h60-h95), within the section covering diseases of external ear (h60-h62).

H60.531 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.

Document the specific contact agent (e.g., jewelry, hearing aid, water) when available.

Question 2

Is H60.531 an HCC code?

Accepted Answer

No. H60.531 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 H60.531 billable?

Accepted Answer

Yes. H60.531 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. H60.531 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 H60.531?

Accepted Answer

H60.531 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 H60.531 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 H60.531?

Accepted Answer

Document the specific contact agent (e.g., jewelry, hearing aid, water) when available Ensure laterality is clearly documented as right ear to support this specific code

HCC Buddy Code Card

H60.531

Is H60.531 an HCC code?

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Open H60.531 in the Interactive Encoder

H60.531 ICD-10-CM Code: Acute contact otitis externa, right ear

HCC Buddy Code Card

H60.531

Is H60.531 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open H60.531 in the Interactive Encoder