H04.539 ICD-10-CM Code: Neonatal obstruction of unspecified 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)
H04.539
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNeonatal obstruction of unspecified nasolacrimal duct
A newborn has a blocked tear drainage duct, but the specific eye or whether one or both eyes are affected is not documented.
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 H04.539 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H04.539 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H04.539 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 H04.539 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H04.539 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H04.539 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 H04.539 an HCC code?
No. H04.539 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
H04.539 is the ICD-10-CM diagnosis code for neonatal obstruction of unspecified nasolacrimal duct. A newborn has a blocked tear drainage duct, but the specific eye or whether one or both eyes are affected is not documented. H04.539 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).
H04.539 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 only when laterality is not specified in the medical record.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H04.539 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when laterality is not specified in the medical record
- •Query provider to determine unilateral versus bilateral involvement for accurate coding