2026 ICD-10-CM Diagnosis Code H04.201Unspecified epiphora, right side

ICD-10-CM Codes›H00–H59›H00-H05›H04

ICD-10-CM H04.201
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

H04.201 is a billable ICD-10-CM diagnosis code for unspecified epiphora, right side. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 124 through 125. Coders also document this condition as epiphora of right eye. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Cornea and external disease and Oculofacial plastics and orbital conditions.

Code Identity

ICD-10-CM Code
H04.201
Billable Status
Yes — Valid for Submission
Code Describes
Unspecified epiphora, right side
Short Description
Unspecified epiphora, right side
Same as the full description in the CMS dataset.
Parent Code
H04.20
Unspecified epiphora

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH00-H05Disorders of eyelid, lacrimal system and orbit
CategoryH04Disorders of lacrimal system
This CodeH04.201Unspecified epiphora, right side

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Epiphora of right eye

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR EYE001
Cornea and external disease
Default principal diagnosis: inpatient Yes · outpatient Yes
CCSR EYE008
Oculofacial plastics and orbital conditions
Default principal diagnosis: inpatient No · outpatient No

Patient EducationClinical

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Convert H04.201 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
375.20 Epiphora NOS
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About H04.201Overview

Is H04.201 (Unspecified epiphora) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report unspecified epiphora, right side on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does H04.201 group to?

When unspecified epiphora, right side is the principal diagnosis on an inpatient stay, it groups to MS-DRG 124, 125, with relative weights from 0.7678 to 1.3231 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of H04.201?

Under the General Equivalence Mappings, unspecified epiphora, right side converts to ICD-9-CM 375.20 (epiphora NOS). The mapping is approximate, so confirm the match fits the documentation.

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.