2027 ICD-10-CM Diagnosis Code H04.533Neonatal obstruction of bilateral nasolacrimal duct

ICD-10-CM Codes›H00–H59›H00-H05›H04

ICD-10-CM H04.533
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

H04.533 is a billable ICD-10-CM diagnosis code for neonatal obstruction of bilateral nasolacrimal duct. 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. The code is restricted by the Medicare Code Editor to newborn patients (age 0). In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Oculofacial plastics and orbital conditions.

Code Identity

ICD-10-CM Code
H04.533
Billable Status
Yes — Valid for Submission
Code Describes
Neonatal obstruction of bilateral nasolacrimal duct
Short Description
Neonatal obstruction of bilateral nasolacrimal duct
Same as the full description in the CMS dataset.
Parent Code
H04.53
Neonatal obstruction of nasolacrimal duct

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH00-H05Disorders of eyelid, lacrimal system and orbit
CategoryH04Disorders of lacrimal system
This CodeH04.533Neonatal obstruction of bilateral nasolacrimal duct

Code EditsBilling

Medicare Code Editor checks that affect claim validity for H04.533.

Perinatal / Newborn diagnoses
The Medicare Code Editor detects inconsistencies in perinatal / newborn cases by checking a patient's age and any diagnosis on the patient's record. The newborn code edits apply to patients age 0 years only; a subset of diagnoses which will only occur during the perinatal or newborn period of age 0 (e.g., tetanus neonatorum, health examination for newborn under 8 days old).

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to H04.533: its own notes plus those printed at H04.53, 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 H04.53 Neonatal obstruction of nasolacrimal duct applies to 4 codes
  • congenital stenosis and stricture of lacrimal duct (Q10.5)
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 EYE008
Oculofacial plastics and orbital conditions
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Tears

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Read the full article at MedlinePlus

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

Convert H04.533 to ICD-9-CMHistory

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

ICD-9-CM
375.55 Neonatal nasolacrml obst
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 H04.533Overview

What is the ICD-10 code for neonatal obstruction of bilateral nasolacrimal duct?

The ICD-10-CM code for neonatal obstruction of bilateral nasolacrimal duct is H04.533 (sometimes written as H04533). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is H04.533 (Neonatal obstruction of nasolacrimal duct) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report neonatal obstruction of bilateral nasolacrimal duct on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does H04.533 group to?

When neonatal obstruction of bilateral nasolacrimal duct 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.

Who can H04.533 be reported for?

The Medicare Code Editor checks neonatal obstruction of bilateral nasolacrimal duct against patient demographics: this code is intended for newborn patients (age 0). Claims outside these limits are flagged as inconsistent.

Can H04.533 be reported with Q10.5?

Not as a rule. The Excludes1 note at H04.53, which applies to H04.533, lists "congenital stenosis and stricture of lacrimal duct (Q10.5)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).