2026 ICD-10-CM Diagnosis Code H04.539Neonatal obstruction of unspecified nasolacrimal duct

ICD-10-CM Codes›H00–H59›H00-H05›H04

ICD-10-CM H04.539
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

H04.539 is a billable ICD-10-CM diagnosis code for neonatal obstruction of unspecified nasolacrimal duct. 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. The code is restricted by the Medicare Code Editor to newborn patients (age 0). Coders also document this condition as acquired nasolacrimal duct obstruction. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Oculofacial plastics and orbital conditions.

Code Identity

ICD-10-CM Code
H04.539
Billable Status
Yes — Valid for Submission
Code Describes
Neonatal obstruction of unspecified nasolacrimal duct
Short Description
Neonatal obstruction of unspecified 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 CodeH04.539Neonatal obstruction of unspecified nasolacrimal duct

Code EditsBilling

Medicare Code Editor checks that affect claim validity for H04.539.

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).

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Acquired nasolacrimal duct obstruction
  • Neonatal obstruction of nasolacrimal duct
  • Obstruction of nasolacrimal duct

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

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Convert H04.539 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 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About H04.539Overview

Is H04.539 (Neonatal obstruction of nasolacrimal duct) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report neonatal obstruction of unspecified nasolacrimal duct on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does H04.539 group to?

When neonatal obstruction of unspecified nasolacrimal duct 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.

Who can H04.539 be reported for?

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

What is the ICD-9 equivalent of H04.539?

Under the General Equivalence Mappings, neonatal obstruction of unspecified nasolacrimal duct converts to ICD-9-CM 375.55 (neonatal nasolacrml obst). 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.