Is H16.221 a billable ICD-10-CM code?

Yes. H16.221 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does H16.221 sit in the tabular list?

Diseases of the eye and adnexa (H00-H59), in the block Disorders of sclera, cornea, iris and ciliary body (H15-H22).

What cannot be coded together with H16.221?

H16.221 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H16.221 (H16.22) and apply to it just the same.

H16.221

H16.221 — Keratoconjunctivitis sicca, not specified as Sjogren's, right eye

Billable / specific codeICD-10-CMright

H16.221 is a billable, specific ICD-10-CM code for keratoconjunctivitis sicca, not specified as sjogren's, right eye. It is valid for submission on a claim.

Excludes1 inherited from the categories above H16.221

These are not written on H16.221, but they bind it: a note on a category applies to every code beneath it. Billing H16.221 with anything listed here is a denial.

Written on H16.22 — Keratoconjunctivitis sicca, not specified as Sjogren's

Sjögren's syndrome (M35.01)

Risk adjustment

H16.221 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

H16.221 is named in 2 Medicare coverage policies — 2 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A57068Billing and Coding: Ocular Photography - External
A57637Billing and Coding: Visual Field Examination

Code history

H16.221 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share H16.22. If H16.221 is not quite right, the correct code is usually one of these.

Questions about H16.221

Is H16.221 a billable ICD-10-CM code?: Yes. H16.221 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does H16.221 sit in the tabular list?: Diseases of the eye and adnexa (H00-H59), in the block Disorders of sclera, cornea, iris and ciliary body (H15-H22).
What cannot be coded together with H16.221?: H16.221 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H16.221 (H16.22) and apply to it just the same.