What is ICD-10 code H04.222?

H04.222 is the ICD-10-CM diagnosis code for Epiphora due to insufficient drainage, left side. It belongs to the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59). H04.222 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. H04.222 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. H04.222 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. H04.222 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does H04.222 map to under V28?

H04.222 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

What RAF reference is published for H04.222?

H04.222 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

What is the V28 vs V24 difference for H04.222?

H04.222 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

2026 ICD-10-CM H04.222: Epiphora due to insufficient

H04.222 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupH04.222

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)

H04.222

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

Epiphora due to insufficient drainage, left side

Excessive tearing in the left eye caused by the tear drainage system not working properly, leading to tears overflowing onto the cheek. This occurs when tears cannot drain adequately through the normal drainage channels.

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

H04.2Epiphora H04.22Epiphora due to insufficient drainage H04.222Epiphora due to insufficient drainage, left side

Inclusion Terms

Official

No inclusion terms are included in this display for H04.222. 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

H04.221Epiphora due to insufficient drainage, right side H04.223Epiphora due to insufficient drainage, bilateral H04.229Epiphora due to insufficient drainage, unspecified side

Includes

Official

No Includes notes are included in this display for H04.222. 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 H04.222. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for H04.222. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for H04.222. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Verify laterality is documented as left side (H04.221 for right, H04.223 for bilateral) before assigning this code

Ensure the medical record specifies that epiphora is due to insufficient drainage rather than other causes like obstruction or eyelid malposition, as this affects code selection

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 H04.222 an HCC code?

No. H04.222 is a billable ICD-10-CM code with no mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models.

Code: H04.222
Description: Epiphora due to insufficient drainage, left side
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).

What This Code Means

H04.222 is the ICD-10-CM diagnosis code for epiphora due to insufficient drainage, left side. Excessive tearing in the left eye caused by the tear drainage system not working properly, leading to tears overflowing onto the cheek. This occurs when tears cannot drain adequately through the normal drainage channels. H04.222 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).

H04.222 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, 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 laterality is documented as left side (H04.221 for right, H04.223 for bilateral) before assigning this code.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H04.222 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify laterality is documented as left side (H04.221 for right, H04.223 for bilateral) before assigning this code
•Ensure the medical record specifies that epiphora is due to insufficient drainage rather than other causes like obstruction or eyelid malposition, as this affects code selection