H04.139 ICD-10-CM Code: Lacrimal cyst, unspecified lacrimal gland
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of eyelid, lacrimal system and orbit (H00-H05)
H04.139
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLacrimal cyst, unspecified lacrimal gland
A fluid-filled sac or pocket that develops in one of the tear glands (lacrimal glands) that produce tears, but the specific location within the gland is not documented. This condition can cause mild discomfort, swelling, or tearing problems depending on the cyst's size.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Code Book Path
Inclusion Terms
Official- Lacrimal cystic degeneration
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H04.139 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H04.139 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H04.139 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H04.139 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H04.139 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H04.139 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H04.139 an HCC code?
No. H04.139 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H04.139 is the ICD-10-CM diagnosis code for lacrimal cyst, unspecified lacrimal gland. A fluid-filled sac or pocket that develops in one of the tear glands (lacrimal glands) that produce tears, but the specific location within the gland is not documented. This condition can cause mild discomfort, swelling, or tearing problems depending on the cyst's size. H04.139 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).
H04.139 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Use this code only when the documentation does not specify which lacrimal gland (right or left) or which part of the gland is affected; if laterality is documented, use the more specific codes H04.131 (right) or H04.132 (left).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H04.139 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the documentation does not specify which lacrimal gland (right or left) or which part of the gland is affected; if laterality is documented, use the more specific codes H04.131 (right) or H04.132 (left)
- •Verify whether the cyst is causing any symptoms or complications, as this may affect treatment decisions and documentation; ensure the provider has documented that the specific location is unknown before assigning the 'unspecified' code