ICD-10 · PDGM grouping
H04 Disorders of lacrimal system
All 120 codes in the H04 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.
ICD-10-CM FY2027 · CMS grouper v07.2.26
Codes in family
120
Can lead a claim
90
Cannot lead a claim
30
What CMS assigns to H04
90 of the 120 codes group to MMTA - Other; 30 are assigned no clinical group. None of the 120 is assigned a comorbidity subgroup. 90 of the 120 can lead a claim.
Every code in H04
Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.
| Code | Description | Primary position | Clinical group | Comorbidity subgroup |
|---|---|---|---|---|
| H04.0 Dacryoadenitis | ||||
| H04.00 Unspecified dacryoadenitis | ||||
| H04.001 | Unspecified dacryoadenitis, right lacrimal gland | Can lead a claim | A | None |
| H04.002 | Unspecified dacryoadenitis, left lacrimal gland | Can lead a claim | A | None |
| H04.003 | Unspecified dacryoadenitis, bilateral lacrimal glands | Can lead a claim | A | None |
| H04.009 | Unspecified dacryoadenitis, unspecified lacrimal gland | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.01 Acute dacryoadenitis | ||||
| H04.011 | Acute dacryoadenitis, right lacrimal gland | Can lead a claim | A | None |
| H04.012 | Acute dacryoadenitis, left lacrimal gland | Can lead a claim | A | None |
| H04.013 | Acute dacryoadenitis, bilateral lacrimal glands | Can lead a claim | A | None |
| H04.019 | Acute dacryoadenitis, unspecified lacrimal gland | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.02 Chronic dacryoadenitis | ||||
| H04.021 | Chronic dacryoadenitis, right lacrimal gland | Can lead a claim | A | None |
| H04.022 | Chronic dacryoadenitis, left lacrimal gland | Can lead a claim | A | None |
| H04.023 | Chronic dacryoadenitis, bilateral lacrimal gland | Can lead a claim | A | None |
| H04.029 | Chronic dacryoadenitis, unspecified lacrimal gland | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.03 Chronic enlargement of lacrimal gland | ||||
| H04.031 | Chronic enlargement of right lacrimal gland | Can lead a claim | A | None |
| H04.032 | Chronic enlargement of left lacrimal gland | Can lead a claim | A | None |
| H04.033 | Chronic enlargement of bilateral lacrimal glands | Can lead a claim | A | None |
| H04.039 | Chronic enlargement of unspecified lacrimal gland | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.1 Other disorders of lacrimal gland | ||||
| H04.11 Dacryops | ||||
| H04.111 | Dacryops of right lacrimal gland | Can lead a claim | A | None |
| H04.112 | Dacryops of left lacrimal gland | Can lead a claim | A | None |
| H04.113 | Dacryops of bilateral lacrimal glands | Can lead a claim | A | None |
| H04.119 | Dacryops of unspecified lacrimal gland | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.12 Dry eye syndrome | ||||
| H04.121 | Dry eye syndrome of right lacrimal gland | Can lead a claim | A | None |
| H04.122 | Dry eye syndrome of left lacrimal gland | Can lead a claim | A | None |
| H04.123 | Dry eye syndrome of bilateral lacrimal glands | Can lead a claim | A | None |
| H04.129 | Dry eye syndrome of unspecified lacrimal gland | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.13 Lacrimal cyst | ||||
| H04.131 | Lacrimal cyst, right lacrimal gland | Can lead a claim | A | None |
| H04.132 | Lacrimal cyst, left lacrimal gland | Can lead a claim | A | None |
| H04.133 | Lacrimal cyst, bilateral lacrimal glands | Can lead a claim | A | None |
| H04.139 | Lacrimal cyst, unspecified lacrimal gland | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.14 Primary lacrimal gland atrophy | ||||
| H04.141 | Primary lacrimal gland atrophy, right lacrimal gland | Can lead a claim | A | None |
| H04.142 | Primary lacrimal gland atrophy, left lacrimal gland | Can lead a claim | A | None |
| H04.143 | Primary lacrimal gland atrophy, bilateral lacrimal glands | Can lead a claim | A | None |
| H04.149 | Primary lacrimal gland atrophy, unspecified lacrimal gland | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.15 Secondary lacrimal gland atrophy | ||||
| H04.151 | Secondary lacrimal gland atrophy, right lacrimal gland | Can lead a claim | A | None |
| H04.152 | Secondary lacrimal gland atrophy, left lacrimal gland | Can lead a claim | A | None |
| H04.153 | Secondary lacrimal gland atrophy, bilateral lacrimal glands | Can lead a claim | A | None |
| H04.159 | Secondary lacrimal gland atrophy, unspecified lacrimal gland | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.16 Lacrimal gland dislocation | ||||
| H04.161 | Lacrimal gland dislocation, right lacrimal gland | Can lead a claim | A | None |
| H04.162 | Lacrimal gland dislocation, left lacrimal gland | Can lead a claim | A | None |
| H04.163 | Lacrimal gland dislocation, bilateral lacrimal glands | Can lead a claim | A | None |
| H04.169 | Lacrimal gland dislocation, unspecified lacrimal gland | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.19 | Other specified disorders of lacrimal gland | Can lead a claim | A | None |
| H04.2 Epiphora | ||||
| H04.20 Unspecified epiphora | ||||
| H04.201 | Unspecified epiphora, right side | Can lead a claim | A | None |
| H04.202 | Unspecified epiphora, left side | Can lead a claim | A | None |
| H04.203 | Unspecified epiphora, bilateral | Can lead a claim | A | None |
| H04.209 | Unspecified epiphora, unspecified side | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.21 Epiphora due to excess lacrimation | ||||
| H04.211 | Epiphora due to excess lacrimation, right lacrimal gland | Can lead a claim | A | None |
| H04.212 | Epiphora due to excess lacrimation, left lacrimal gland | Can lead a claim | A | None |
| H04.213 | Epiphora due to excess lacrimation, bilateral lacrimal glandsCMS: Epiphora due to excess lacrimation, bi lacrimal glands | Can lead a claim | A | None |
| H04.219 | Epiphora due to excess lacrimation, unspecified lacrimal glandCMS: Epiphora due to excess lacrimation, unsp lacrimal gland | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.22 Epiphora due to insufficient drainage | ||||
| H04.221 | Epiphora due to insufficient drainage, right side | Can lead a claim | A | None |
| H04.222 | Epiphora due to insufficient drainage, left side | Can lead a claim | A | None |
| H04.223 | Epiphora due to insufficient drainage, bilateral | Can lead a claim | A | None |
| H04.229 | Epiphora due to insufficient drainage, unspecified side | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.3 Acute and unspecified inflammation of lacrimal passages | ||||
| H04.30 Unspecified dacryocystitis | ||||
| H04.301 | Unspecified dacryocystitis of right lacrimal passage | Can lead a claim | A | None |
| H04.302 | Unspecified dacryocystitis of left lacrimal passage | Can lead a claim | A | None |
| H04.303 | Unspecified dacryocystitis of bilateral lacrimal passages | Can lead a claim | A | None |
| H04.309 | Unspecified dacryocystitis of unspecified lacrimal passage | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.31 Phlegmonous dacryocystitis | ||||
| H04.311 | Phlegmonous dacryocystitis of right lacrimal passage | Can lead a claim | A | None |
| H04.312 | Phlegmonous dacryocystitis of left lacrimal passage | Can lead a claim | A | None |
| H04.313 | Phlegmonous dacryocystitis of bilateral lacrimal passages | Can lead a claim | A | None |
| H04.319 | Phlegmonous dacryocystitis of unspecified lacrimal passage | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.32 Acute dacryocystitis | ||||
| H04.321 | Acute dacryocystitis of right lacrimal passage | Can lead a claim | A | None |
| H04.322 | Acute dacryocystitis of left lacrimal passage | Can lead a claim | A | None |
| H04.323 | Acute dacryocystitis of bilateral lacrimal passages | Can lead a claim | A | None |
| H04.329 | Acute dacryocystitis of unspecified lacrimal passage | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.33 Acute lacrimal canaliculitis | ||||
| H04.331 | Acute lacrimal canaliculitis of right lacrimal passage | Can lead a claim | A | None |
| H04.332 | Acute lacrimal canaliculitis of left lacrimal passage | Can lead a claim | A | None |
| H04.333 | Acute lacrimal canaliculitis of bilateral lacrimal passages | Can lead a claim | A | None |
| H04.339 | Acute lacrimal canaliculitis of unspecified lacrimal passage | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.4 Chronic inflammation of lacrimal passages | ||||
| H04.41 Chronic dacryocystitis | ||||
| H04.411 | Chronic dacryocystitis of right lacrimal passage | Can lead a claim | A | None |
| H04.412 | Chronic dacryocystitis of left lacrimal passage | Can lead a claim | A | None |
| H04.413 | Chronic dacryocystitis of bilateral lacrimal passages | Can lead a claim | A | None |
| H04.419 | Chronic dacryocystitis of unspecified lacrimal passage | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.42 Chronic lacrimal canaliculitis | ||||
| H04.421 | Chronic lacrimal canaliculitis of right lacrimal passage | Can lead a claim | A | None |
| H04.422 | Chronic lacrimal canaliculitis of left lacrimal passage | Can lead a claim | A | None |
| H04.423 | Chronic lacrimal canaliculitis of bilateral lacrimal passagesCMS: Chronic lacrimal canaliculitis of bi lacrimal passages | Can lead a claim | A | None |
| H04.429 | Chronic lacrimal canaliculitis of unspecified lacrimal passageCMS: Chronic lacrimal canaliculitis of unsp lacrimal passage | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.43 Chronic lacrimal mucocele | ||||
| H04.431 | Chronic lacrimal mucocele of right lacrimal passage | Can lead a claim | A | None |
| H04.432 | Chronic lacrimal mucocele of left lacrimal passage | Can lead a claim | A | None |
| H04.433 | Chronic lacrimal mucocele of bilateral lacrimal passages | Can lead a claim | A | None |
| H04.439 | Chronic lacrimal mucocele of unspecified lacrimal passage | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.5 Stenosis and insufficiency of lacrimal passages | ||||
| H04.51 Dacryolith | ||||
| H04.511 | Dacryolith of right lacrimal passage | Can lead a claim | A | None |
| H04.512 | Dacryolith of left lacrimal passage | Can lead a claim | A | None |
| H04.513 | Dacryolith of bilateral lacrimal passages | Can lead a claim | A | None |
| H04.519 | Dacryolith of unspecified lacrimal passage | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.52 Eversion of lacrimal punctum | ||||
| H04.521 | Eversion of right lacrimal punctum | Can lead a claim | A | None |
| H04.522 | Eversion of left lacrimal punctum | Can lead a claim | A | None |
| H04.523 | Eversion of bilateral lacrimal punctum | Can lead a claim | A | None |
| H04.529 | Eversion of unspecified lacrimal punctum | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.53 Neonatal obstruction of nasolacrimal duct | ||||
| H04.531 | Neonatal obstruction of right nasolacrimal duct | Can lead a claim | A | None |
| H04.532 | Neonatal obstruction of left nasolacrimal duct | Can lead a claim | A | None |
| H04.533 | Neonatal obstruction of bilateral nasolacrimal duct | Can lead a claim | A | None |
| H04.539 | Neonatal obstruction of unspecified nasolacrimal duct | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.54 Stenosis of lacrimal canaliculi | ||||
| H04.541 | Stenosis of right lacrimal canaliculi | Can lead a claim | A | None |
| H04.542 | Stenosis of left lacrimal canaliculi | Can lead a claim | A | None |
| H04.543 | Stenosis of bilateral lacrimal canaliculi | Can lead a claim | A | None |
| H04.549 | Stenosis of unspecified lacrimal canaliculi | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.55 Acquired stenosis of nasolacrimal duct | ||||
| H04.551 | Acquired stenosis of right nasolacrimal duct | Can lead a claim | A | None |
| H04.552 | Acquired stenosis of left nasolacrimal duct | Can lead a claim | A | None |
| H04.553 | Acquired stenosis of bilateral nasolacrimal duct | Can lead a claim | A | None |
| H04.559 | Acquired stenosis of unspecified nasolacrimal duct | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.56 Stenosis of lacrimal punctum | ||||
| H04.561 | Stenosis of right lacrimal punctum | Can lead a claim | A | None |
| H04.562 | Stenosis of left lacrimal punctum | Can lead a claim | A | None |
| H04.563 | Stenosis of bilateral lacrimal punctum | Can lead a claim | A | None |
| H04.569 | Stenosis of unspecified lacrimal punctum | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.57 Stenosis of lacrimal sac | ||||
| H04.571 | Stenosis of right lacrimal sac | Can lead a claim | A | None |
| H04.572 | Stenosis of left lacrimal sac | Can lead a claim | A | None |
| H04.573 | Stenosis of bilateral lacrimal sac | Can lead a claim | A | None |
| H04.579 | Stenosis of unspecified lacrimal sac | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.6 Other changes of lacrimal passages | ||||
| H04.61 Lacrimal fistula | ||||
| H04.611 | Lacrimal fistula right lacrimal passage | Can lead a claim | A | None |
| H04.612 | Lacrimal fistula left lacrimal passage | Can lead a claim | A | None |
| H04.613 | Lacrimal fistula bilateral lacrimal passages | Can lead a claim | A | None |
| H04.619 | Lacrimal fistula unspecified lacrimal passage | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.69 | Other changes of lacrimal passages | Can lead a claim | A | None |
| H04.8 Other disorders of lacrimal system | ||||
| H04.81 Granuloma of lacrimal passages | ||||
| H04.811 | Granuloma of right lacrimal passage | Can lead a claim | A | None |
| H04.812 | Granuloma of left lacrimal passage | Can lead a claim | A | None |
| H04.813 | Granuloma of bilateral lacrimal passages | Can lead a claim | A | None |
| H04.819 | Granuloma of unspecified lacrimal passage | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| H04.89 | Other disorders of lacrimal system | Can lead a claim | A | None |
| H04.9 | Disorder of lacrimal system, unspecified | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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