Q10.0 ICD-10-CM Code: Congenital ptosis
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 / Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0) / Congenital malformations of eye, ear, face and neck (Q10-Q18)
Q10.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCongenital ptosis
A birth defect where the eyelid droops due to weakness or underdevelopment of the muscles that lift the eyelid.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for Q10.0 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Q10.0 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Q10.0 in this effective period.
Excludes 1
Official- cryptophthalmos NOS (Q11.2)
- cryptophthalmos syndrome (Q87.0)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Q10.0 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Q10.0 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Q10.0 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 Q10.0 an HCC code?
No. Q10.0 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- Q10.0
- Description
- Congenital ptosis
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- 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
Q10.0 is the ICD-10-CM diagnosis code for congenital ptosis. A birth defect where the eyelid droops due to weakness or underdevelopment of the muscles that lift the eyelid. Q10.0 sits in the ICD-10-CM chapter for congenital malformations, deformations and chromosomal abnormalities (q00-qa0), within the section covering congenital malformations of eye, ear, face and neck (q10-q18).
Q10.0 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.
Specify laterality (right, left, or bilateral) in documentation to support accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q10.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify laterality (right, left, or bilateral) in documentation to support accurate coding
- •Distinguish from acquired ptosis (H02.4) which develops after birth