Is H04.613 a billable ICD-10-CM code?

Yes. H04.613 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does H04.613 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 H04.613?

H04.613 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 H04.613 (H04) and apply to it just the same.

H04.613

H04.613 — Lacrimal fistula bilateral lacrimal passages

Billable / specific codeICD-10-CMbilateral

H04.613 is a billable, specific ICD-10-CM code for lacrimal fistula bilateral lacrimal passages. It is valid for submission on a claim.

Excludes1 inherited from the categories above H04.613

These are not written on H04.613, but they bind it: a note on a category applies to every code beneath it. Billing H04.613 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

H04.613 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

H04.613 is named in 1 Medicare coverage policy — 1 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

Code history

H04.613 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share H04.61. If H04.613 is not quite right, the correct code is usually one of these.

Questions about H04.613

Is H04.613 a billable ICD-10-CM code?: Yes. H04.613 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does H04.613 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 H04.613?: H04.613 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 H04.613 (H04) and apply to it just the same.