H04.569 ICD-10-CM Code: Stenosis of unspecified lacrimal punctum
H04.569 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software
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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)
H04.569
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceStenosis of unspecified lacrimal punctum
The tear drainage opening (punctum) in the eye is abnormally narrowed or blocked, preventing tears from draining properly. This can cause excessive tearing and eye irritation.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
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 H04.569 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H04.569 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H04.569 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H04.569 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H04.569 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H04.569 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H04.569 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 H04.569 an HCC code?
No. H04.569 is a billable ICD-10-CM code with no mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models.
- Code
- H04.569
- Description
- Stenosis of unspecified lacrimal punctum
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- 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
H04.569 is the ICD-10-CM diagnosis code for stenosis of unspecified lacrimal punctum. The tear drainage opening (punctum) in the eye is abnormally narrowed or blocked, preventing tears from draining properly. This can cause excessive tearing and eye irritation. H04.569 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).
H04.569 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.
Use this code only when the specific lacrimal punctum (upper or lower) is not documented; if laterality is specified, use H04.561 (right) or H04.562 (left) instead.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for H04.569 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the specific lacrimal punctum (upper or lower) is not documented; if laterality is specified, use H04.561 (right) or H04.562 (left) instead
- •Stenosis indicates narrowing of the punctal opening; if complete blockage is documented, verify whether stenosis or obstruction is the more accurate diagnosis