Is H04 a billable ICD-10-CM code?

No. H04 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does H04 sit in the tabular list?

Diseases of the eye and adnexa (H00-H59), in the block Disorders of eyelid, lacrimal system and orbit (H00-H05).

What cannot be coded together with H04?

H04 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

H04

H04 — Disorders of lacrimal system

Non-billable headerICD-10-CM

H04 is a non-billable header ICD-10-CM code for disorders of lacrimal system. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

congenital malformations of lacrimal system (Q10.4-Q10.6)

Risk adjustment

H04 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code to one of these instead H04

9 child codes. Green means billable.

Questions about H04

Is H04 a billable ICD-10-CM code?: No. H04 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does H04 sit in the tabular list?: Diseases of the eye and adnexa (H00-H59), in the block Disorders of eyelid, lacrimal system and orbit (H00-H05).
What cannot be coded together with H04?: H04 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.