Is H04.1 a billable ICD-10-CM code?

No. H04.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does H04.1 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 H04.1?

H04.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H04.1 (H04) and apply to it just the same.

H04.1

H04.1 — Other disorders of lacrimal gland

Non-billable headerICD-10-CM

H04.1 is a non-billable header ICD-10-CM code for other disorders of lacrimal gland. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 inherited from the categories above H04.1

These are not written on H04.1, but they bind it: a note on a category applies to every code beneath it. Billing H04.1 with anything listed here is a denial.

Written on H04 — Disorders of lacrimal system

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

Risk adjustment

H04.1 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 history

H04.1 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead H04.1

7 child codes. Green means billable.

Related codes at this level

Codes that share H04. If H04.1 is not quite right, the correct code is usually one of these.

Questions about H04.1

Is H04.1 a billable ICD-10-CM code?: No. H04.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does H04.1 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 H04.1?: H04.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H04.1 (H04) and apply to it just the same.