2027 ICD-10-CM Diagnosis Code H04.223Epiphora due to insufficient drainage, bilateral

ICD-10-CM Codes›H00–H59›H00-H05›H04

ICD-10-CM H04.223
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

H04.223 is a billable ICD-10-CM diagnosis code for epiphora due to insufficient drainage, bilateral. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 124 through 125. Coders also document this condition as bilateral epiphora of eyes. 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
H04.223
Billable Status
Yes — Valid for Submission
Code Describes
Epiphora due to insufficient drainage, bilateral
Short Description
Epiphora due to insufficient drainage, bilateral
Same as the full description in the CMS dataset.
Parent Code
H04.22
Epiphora due to insufficient drainage

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH00-H05Disorders of eyelid, lacrimal system and orbit
CategoryH04Disorders of lacrimal system
This CodeH04.223Epiphora due to insufficient drainage, bilateral

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Bilateral epiphora of eyes
  • Bilateral epiphora of eyes due to tear drainage disorder
  • Epiphora of left eye
  • Epiphora of left eye due to tear drainage disorder
  • Epiphora of right eye
  • Epiphora of right eye due to tear drainage disorder

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to H04.223: its own notes plus those printed at H04, block H00-H05, and Chapter 7. A note printed at a category, block or chapter applies to every code under it.

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From H04 Disorders of lacrimal system applies to 120 codes
  • congenital malformations of lacrimal system (Q10.4-Q10.6)

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From Block H00-H05 Disorders of eyelid, lacrimal system and orbit applies to 574 codes
From Chapter 7 (H00-H59) Diseases of the eye and adnexa applies to 2,677 codes
  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
  • diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury (trauma) of eye and orbit (S05.-)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
  • syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)

Notes

General instructions on how these codes are used.

From Chapter 7 (H00-H59) Diseases of the eye and adnexa applies to 2,677 codes
  • Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

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

Clinical InformationClinical

  • Epiphora

    excessive tearing of the eyes due to either tear overproduction or impaired drainage of the tear ducts. causes of tear overproduction include eye irritation (e.g., eye infection, foreign body in the eye), headache, pain reaction, allergies, sinusitis, and injury to the eye.

Patient EducationClinical

Tears

You may only think of tears as those salty drops that fall from your eyes when you cry. Actually, your tears clean your eyes every time you blink. Tears also keep your eyes moist, which is important for your vision.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert H04.223 to ICD-9-CMHistory

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

ICD-9-CM
375.22 Epiphora d/t insuf drain
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 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About H04.223Overview

What is the ICD-10 code for epiphora due to insufficient drainage, bilateral?

The ICD-10-CM code for epiphora due to insufficient drainage, bilateral is H04.223 (sometimes written as H04223). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is H04.223 (Epiphora due to insufficient drainage) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report epiphora due to insufficient drainage, bilateral on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does H04.223 group to?

When epiphora due to insufficient drainage, bilateral is the principal diagnosis on an inpatient stay, it groups to MS-DRG 125, 124, with relative weights from 0.7699 to 1.2470 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of H04.223?

Under the General Equivalence Mappings, epiphora due to insufficient drainage, bilateral converts to ICD-9-CM 375.22 (epiphora d/t insuf drain). The mapping is approximate, so confirm the match fits the documentation.