2026 ICD-10-CM Diagnosis Code H04.549Stenosis of unspecified lacrimal canaliculi

ICD-10-CM Codes›H00–H59›H00-H05›H04

ICD-10-CM H04.549
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

H04.549 is a billable ICD-10-CM diagnosis code for stenosis of unspecified lacrimal canaliculi. 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 complete obstruction of lacrimal canaliculus. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Oculofacial plastics and orbital conditions.

Code Identity

ICD-10-CM Code
H04.549
Billable Status
Yes — Valid for Submission
Code Describes
Stenosis of unspecified lacrimal canaliculi
Short Description
Stenosis of unspecified lacrimal canaliculi
Same as the full description in the CMS dataset.
Parent Code
H04.54
Stenosis of lacrimal canaliculi

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH00-H05Disorders of eyelid, lacrimal system and orbit
CategoryH04Disorders of lacrimal system
This CodeH04.549Stenosis of unspecified lacrimal canaliculi

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Complete obstruction of lacrimal canaliculus
  • Drug induced lacrimal canalicular stenosis
  • Obstruction of lacrimal canaliculus
  • Stenosis of lacrimal canaliculi

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 H04.549 to ICD-9-CMHistory

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

ICD-9-CM
375.53 Lacrim canalic stenosis
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 H04.549Overview

Is H04.549 (Stenosis of lacrimal canaliculi) a billable code?

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

What MS-DRG does H04.549 group to?

When stenosis of unspecified lacrimal canaliculi 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 H04.549?

Under the General Equivalence Mappings, stenosis of unspecified lacrimal canaliculi converts to ICD-9-CM 375.53 (lacrim canalic stenosis). 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.