2026 ICD-10-CM Diagnosis Code H04.523Eversion of bilateral lacrimal punctum

ICD-10-CM Codes›H00–H59›H00-H05›H04

ICD-10-CM H04.523
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

H04.523 is a billable ICD-10-CM diagnosis code for eversion of bilateral lacrimal punctum. 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 eversion of lacrimal punctum. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Oculofacial plastics and orbital conditions.

Code Identity

ICD-10-CM Code
H04.523
Billable Status
Yes — Valid for Submission
Code Describes
Eversion of bilateral lacrimal punctum
Short Description
Eversion of bilateral lacrimal punctum
Same as the full description in the CMS dataset.
Parent Code
H04.52
Eversion of lacrimal punctum

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH00-H05Disorders of eyelid, lacrimal system and orbit
CategoryH04Disorders of lacrimal system
This CodeH04.523Eversion of bilateral lacrimal punctum

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Eversion of lacrimal punctum
  • Eversion of lacrimal punctum of bilateral eyelids
  • Eversion of lacrimal punctum of left eyelid
  • Eversion of lacrimal punctum of right eyelid

Clinical ClassificationClinical

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

CCSR EYE008
Oculofacial plastics and orbital conditions
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

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Convert H04.523 to ICD-9-CMHistory

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

ICD-9-CM
375.51 Lacriml punctum eversion
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 H04.523Overview

Is H04.523 (Eversion of lacrimal punctum) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report eversion of bilateral lacrimal punctum on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does H04.523 group to?

When eversion of bilateral lacrimal punctum 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 H04.523?

Under the General Equivalence Mappings, eversion of bilateral lacrimal punctum converts to ICD-9-CM 375.51 (lacriml punctum eversion). 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.