H04.543
H04.543 — Stenosis of bilateral lacrimal canaliculi
Billable / specific codeICD-10-CMbilateral
H04.543 is a billable, specific ICD-10-CM code for stenosis of bilateral lacrimal canaliculi. It is valid for submission on a claim.
Risk adjustment
H04.543 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.
Medicare coverage
H04.543 is named in 2 Medicare coverage policies — 2 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A57068Billing and Coding: Ocular Photography - External
- A57284Billing and Coding: Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation
Related codes at this level
Codes that share H04.54. If H04.543 is not quite right, the correct code is usually one of these.
Questions about H04.543
- Is H04.543 a billable ICD-10-CM code?
- Yes. H04.543 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does H04.543 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).