H04.553 ICD-10-CM Code: Acquired stenosis of bilateral 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)
H04.553
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAcquired stenosis of bilateral nasolacrimal duct
This condition occurs when both tear drainage ducts (one on each side of the nose) become abnormally narrowed or blocked, preventing tears from draining properly from the eyes. This is an acquired condition, meaning it developed over time rather than being present from birth.
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 H04.553 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H04.553 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H04.553 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H04.553 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H04.553 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H04.553 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H04.553 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 H04.553 an HCC code?
No. H04.553 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
H04.553 is the ICD-10-CM diagnosis code for acquired stenosis of bilateral nasolacrimal duct. This condition occurs when both tear drainage ducts (one on each side of the nose) become abnormally narrowed or blocked, preventing tears from draining properly from the eyes. This is an acquired condition, meaning it developed over time rather than being present from birth. H04.553 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).
H04.553 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.
Verify that the stenosis is bilateral (affecting both sides) before assigning this code; if only one side is affected, use the unilateral code H04.551 instead.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H04.553 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that the stenosis is bilateral (affecting both sides) before assigning this code; if only one side is affected, use the unilateral code H04.551 instead
- •Document whether this is a primary acquired stenosis or secondary to trauma, inflammation, or previous surgery, as this may affect clinical management and documentation clarity