Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesDisorders of eyelid, lacrimal system and orbitICD-10-CM h04-disorders-of-lacrimal-system
    Ask Trek AI about this page

    ICD-10-CM Code For Disorders Of Lacrimal System: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group H04 includes conditions affecting the lacrimal apparatus such as tear production disorders, nasolacrimal duct obstruction, dacryocystitis, and other disorders of the lacrimal drainage system. These ICD-10-CM diagnosis codes are used to document clinical presentations like chronic tearing, infection or inflammation of lacrimal structures, and mechanical or functional obstructions impacting ocular surface health. Accurate coding within the ICD-10-CM H04 group supports proper claim adjudication, complete clinical documentation, and appropriate reimbursement.

    Customize your policy alerts

    Sign up for ICD-10-CM Code For Disorders Of Lacrimal System: Group Overview policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    ICD-10-CM H04: Disorders Of Lacrimal System Overview

    The ICD-10-CM H04 diagnoses represent disorders of the lacrimal apparatus, including conditions affecting tear production, drainage, and related structures of the eyelid and orbit. These codes target clinical problems such as epiphora, dacryocystitis, and obstruction or insufficiency of lacrimal ducts. Accurate coding is important for correct claim adjudication and reflects the clinical complexity of ocular surface and lacrimal system care.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    When to Use

    Use a code from this group when documentation indicates a disorder of the lacrimal apparatus such as persistent tearing, infection of the lacrimal sac, or mechanical obstruction of the nasolacrimal duct. Select the code that best matches the documented diagnosis, laterality, and any specified acute or chronic status.

    ICD-10-CM Codes

    120 rows

    ICD-10-CM CodeDescription
    H04.001Unspecified dacryoadenitis, right lacrimal gland
    H04.002Unspecified dacryoadenitis, left lacrimal gland
    H04.003Unspecified dacryoadenitis, bilateral lacrimal glands
    H04.009Unspecified dacryoadenitis, unspecified lacrimal gland
    H04.011Acute dacryoadenitis, right lacrimal gland
    H04.012Acute dacryoadenitis, left lacrimal gland
    H04.013Acute dacryoadenitis, bilateral lacrimal glands
    H04.019Acute dacryoadenitis, unspecified lacrimal gland
    H04.021Chronic dacryoadenitis, right lacrimal gland
    H04.022Chronic dacryoadenitis, left lacrimal gland
    H04.023Chronic dacryoadenitis, bilateral lacrimal gland
    H04.029Chronic dacryoadenitis, unspecified lacrimal gland
    H04.031Chronic enlargement of right lacrimal gland
    H04.032Chronic enlargement of left lacrimal gland
    H04.033Chronic enlargement of bilateral lacrimal glands
    H04.039Chronic enlargement of unspecified lacrimal gland
    H04.111Dacryops of right lacrimal gland
    H04.112Dacryops of left lacrimal gland
    H04.113Dacryops of bilateral lacrimal glands
    H04.119Dacryops of unspecified lacrimal gland

    Showing 1–20 of 120

    DRG Codes

    4 rows

    DRG CodeDescription
    121Acute Major Eye Infections with CC/MCC
    122Acute Major Eye Infections without CC/MCC
    124Other Disorders of the Eye with MCC or Thrombolytic Agent
    125Other Disorders of the Eye without MCC

    Typical Clinical Scenarios

    • An otherwise healthy adult presents to the emergency department with sudden onset of severe tearing, painful swelling near the inner corner of the eye, redness, and purulent discharge that began 24–48 hours earlier. On exam there is a tender, fluctuant swelling along the lacrimal sac region consistent with acute dacryocystitis; an acute infectious disorder of the lacrimal drainage system prompts assignment of an acute lacrimal system diagnosis. Typical codes: H04.211, H04.212
    • An elderly patient with a history of chronic epiphora and recurrent conjunctivitis is referred to ophthalmology for evaluation of long-standing nasolacrimal duct obstruction causing persistent tearing and intermittent mucous discharge. After testing confirms anatomic obstruction of the nasolacrimal duct without acute infection, a chronic obstructive lacrimal disorder code is assigned to reflect the ongoing lacrimal drainage impairment. Typical codes: H04.521, H04.522, H04.529
    • A neonate in the outpatient clinic has persistent unilateral tearing and intermittent ocular crusting since birth; probing and irrigation are planned after conservative measures fail. Because the presentation represents congenital obstruction of the nasolacrimal duct contributing to recurrent ocular irritation, a congenital lacrimal system diagnosis from this group is assigned as a comorbid condition to guide treatment planning. Typical codes: H04.001, H04.002

    Related Codes

    H00-HORDEOLUM-AND-CHALAZION

    ICD-10-CM Code For Hordeolum And Chalazion: Group Overview

    H01-OTHER-INFLAMMATION-OF-EYELID

    ICD-10-CM Code For Other Inflammation Of Eyelid: Group Overview

    H02-OTHER-DISORDERS-OF-EYELID

    ICD-10-CM Code For Other Disorders Of Eyelid: Group Overview

    H05-DISORDERS-OF-ORBIT

    ICD-10-CM Code For Disorders Of Orbit: Group Overview

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.