H04.532 ICD-10-CM Code: Neonatal obstruction of left nasolacrimal duct
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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)
H04.532
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNeonatal obstruction of left nasolacrimal duct
A newborn has a blocked tear drainage duct on the left side, preventing tears from draining properly from that eye.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H04.532 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H04.532 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H04.532 in this effective period.
Excludes 1
Official- congenital stenosis and stricture of lacrimal duct (Q10.5)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H04.532 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H04.532 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H04.532 in this effective period.
Buddy Documentation Tip
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 H04.532 an HCC code?
No. H04.532 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- H04.532
- Description
- Neonatal obstruction of left nasolacrimal duct
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
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
H04.532 is the ICD-10-CM diagnosis code for neonatal obstruction of left nasolacrimal duct. A newborn has a blocked tear drainage duct on the left side, preventing tears from draining properly from that eye. H04.532 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).
H04.532 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.
This is a congenital condition common in newborns; most resolve spontaneously within 12 months.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H04.532 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a congenital condition common in newborns; most resolve spontaneously within 12 months
- •Document whether conservative management (massage) or surgical intervention is planned