H04.419 ICD-10-CM Code: Chronic dacryocystitis of unspecified 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)
H04.419
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceChronic dacryocystitis of unspecified lacrimal passage
This code describes a long-term inflammation of the tear drainage system (lacrimal passages) that has persisted over time, affecting an unspecified location within the tear drainage pathway. The condition causes chronic irritation and swelling of the tear duct system.
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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Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H04.419 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H04.419 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H04.419 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H04.419 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H04.419 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H04.419 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H04.419 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 H04.419 an HCC code?
No. H04.419 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H04.419 is the ICD-10-CM diagnosis code for chronic dacryocystitis of unspecified lacrimal passage. This code describes a long-term inflammation of the tear drainage system (lacrimal passages) that has persisted over time, affecting an unspecified location within the tear drainage pathway. The condition causes chronic irritation and swelling of the tear duct system. H04.419 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).
H04.419 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.
If the specific lacrimal passage location is documented (right eye, left eye, or bilateral), use the more specific codes H04.411, H04.412, or H04.413 instead of the unspecified code H04.419.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H04.419 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •If the specific lacrimal passage location is documented (right eye, left eye, or bilateral), use the more specific codes H04.411, H04.412, or H04.413 instead of the unspecified code H04.419
- •Verify whether the dacryocystitis is acute or chronic, as acute cases use different code ranges (H04.3x); chronic cases use H04.4x codes