H04.311 ICD-10-CM Code: Phlegmonous dacryocystitis of right lacrimal passage
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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)
H04.311
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePhlegmonous dacryocystitis of right lacrimal passage
A severe, spreading infection and inflammation of the tear drainage sac on the right side, characterized by pus formation.
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
OfficialICD-10-CM does not list inclusion terms for H04.311 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H04.311 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H04.311 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H04.311 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H04.311 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H04.311 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H04.311 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 H04.311 an HCC code?
No. H04.311 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
H04.311 is the ICD-10-CM diagnosis code for phlegmonous dacryocystitis of right lacrimal passage. A severe, spreading infection and inflammation of the tear drainage sac on the right side, characterized by pus formation. H04.311 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).
H04.311 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.
Phlegmonous dacryocystitis indicates a more severe, purulent infection compared to unspecified dacryocystitis.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H04.311 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Phlegmonous dacryocystitis indicates a more severe, purulent infection compared to unspecified dacryocystitis
- •This condition may require more aggressive treatment; document presence of abscess or systemic signs if present