H04.209 — Unspecified epiphora, unspecified side
Is H04.209 billable?
Yes, but H04.209 is an unspecified code. H04.209 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, H04.209 is an unspecified or catch-all code. Payers apply additional scrutiny to unspecified codes and many deny them when the medical record supports a more specific option, so check the documentation before selecting H04.209 — the more specific alternatives are listed below.
H04.209 at a glance
| Code | H04.209 |
|---|---|
| Description | Unspecified epiphora, unspecified side |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
Which MS-DRGs does H04.209 group to?
H04.209 sits in MDC 02 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 124Other Disorders of the Eye with MCC or Thrombolytic Agentmedical
- 125Other Disorders of the Eye without MCCmedical
How is H04.209 listed in the Alphabetic Index?
The Alphabetic Index lists these routes under H04.20, the nearest indexed parent of H04.209. Use them to find the family, then select the specific code.
- Epiphora
Excludes1 — never code together — inherited from H04
The conditions below can never be reported together with H04.209 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- congenital malformations of lacrimal system (Q10.4-Q10.6)
Excludes2 — not included here — inherited from Chapter 7
The conditions below are not part of H04.209, but a patient may have both at the same time. When documentation supports it, H04.209 and the excluded code may both be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury (trauma) of eye and orbit (S05.-)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
- syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)
Excludes2 — not included here — inherited from H00-H05
The conditions below are not part of H04.209, but a patient may have both at the same time. When documentation supports it, H04.209 and the excluded code may both be reported.
How long has H04.209 existed?
H04.209 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
- FY2019Unspecified epiphora, unspecified lacrimal glandUnspecified epiphora, unspecified side
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.