H04.022 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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Code lookupH04.022

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of eyelid, lacrimal system and orbit (H00-H05)

H04.022

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Chronic dacryoadenitis, left lacrimal gland

Long-term inflammation of the tear-producing gland in the left eye.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

H04.0Dacryoadenitis H04.02Chronic dacryoadenitis H04.022Chronic dacryoadenitis, left lacrimal gland

Inclusion Terms

Official

No inclusion terms are included in this display for H04.022. Check the code and parent instructions in the Code Book.

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from H00-H59, H00-H05
certain infectious and parasitic diseases (A00-B99)Inherited from H00-H59, H00-H05
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from H00-H59, H00-H05
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from H00-H59, H00-H05
diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)Inherited from H00-H59, H00-H05
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from H00-H59, H00-H05
injury (trauma) of eye and orbit (S05.-)Inherited from H00-H59, H00-H05
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from H00-H59, H00-H05
neoplasms (C00-D49)Inherited from H00-H59, H00-H05
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from H00-H59, H00-H05
syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)Inherited from H00-H59, H00-H05
open wound of eyelid (S01.1-)Inherited from H00-H59, H00-H05
superficial injury of eyelid (S00.1-, S00.2-)Inherited from H00-H59, H00-H05

Related Codes

Official

H04.021Chronic dacryoadenitis, right lacrimal gland H04.023Chronic dacryoadenitis, bilateral lacrimal gland H04.029Chronic dacryoadenitis, unspecified lacrimal gland

Includes

Official

No Includes notes are included in this display for H04.022. Check the code and parent instructions in the Code Book.

Excludes 1

Official

congenital malformations of lacrimal system (Q10.4-Q10.6)Inherited from H04

Code First

Official

No Code First sequencing instructions are included in this display for H04.022. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for H04.022. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for H04.022. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Verify the chronic nature of the condition is documented in the medical record

Distinguish from acute dacryoadenitis (H04.012) based on duration and clinical presentation

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is H04.022 an HCC code?

No. H04.022 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: H04.022
Description: Chronic dacryoadenitis, left lacrimal gland
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

H04.022 is the ICD-10-CM diagnosis code for chronic dacryoadenitis, left lacrimal gland. Long-term inflammation of the tear-producing gland in the left eye. H04.022 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of eyelid, lacrimal system and orbit (h00-h05).

H04.022 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Verify the chronic nature of the condition is documented in the medical record.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H04.022 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify the chronic nature of the condition is documented in the medical record
•Distinguish from acute dacryoadenitis (H04.012) based on duration and clinical presentation