ICD-10 Code H16.221 – Keratoconjunctivitis sicca, not specified as Sjögren’s, right eye (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code H16.221 – Keratoconjunctivitis sicca, not specified as Sjögren’s, right eye
What it is
This code identifies dry eye disease affecting the right eye when it is not documented as part of Sjögren’s syndrome. It indicates reduced tear production or tear film instability with corneal and conjunctival dryness.
Clinical signs
Typical findings include ocular dryness, burning, foreign-body sensation, redness, and irritation. Clinical features vary; refer to documentation for laterality and whether Sjögren’s syndrome is excluded.
When to use this code
Use H16.221 when the record specifically documents keratoconjunctivitis sicca in the right eye and states it is not due to Sjögren’s syndrome. Code it for confirmed unilateral dry eye diagnoses, including specialist assessments that name the right eye. Check documentation if the cause is unclear or if both eyes are involved.
Do not use for
Do not use this code for dry eye linked to Sjögren’s syndrome, bilateral disease, or unspecified eye involvement. If the note does not clearly identify the right eye, check documentation.
Coding tip
Verify both laterality and the “not specified as Sjögren’s” wording before assigning H16.221.