2026 ICD-10-CM Diagnosis Code H04.613Lacrimal fistula bilateral lacrimal passages

ICD-10-CM Codes›H00–H59›H00-H05›H04

ICD-10-CM H04.613
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

H04.613 is a billable ICD-10-CM diagnosis code for lacrimal fistula bilateral lacrimal passages. 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 bilateral lacrimal fistula. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Oculofacial plastics and orbital conditions.

Code Identity

ICD-10-CM Code
H04.613
Billable Status
Yes — Valid for Submission
Code Describes
Lacrimal fistula bilateral lacrimal passages
Short Description
Lacrimal fistula bilateral lacrimal passages
Same as the full description in the CMS dataset.
Parent Code
H04.61
Lacrimal fistula

Code Classification

ChapterH00–H59Diseases of the eye and adnexa
SectionH00-H05Disorders of eyelid, lacrimal system and orbit
CategoryH04Disorders of lacrimal system
This CodeH04.613Lacrimal fistula bilateral lacrimal passages

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Bilateral lacrimal fistula
  • Fistula of left lacrimal apparatus
  • Fistula of right lacrimal apparatus
  • Lacrimal fistula

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 H04.613 to ICD-9-CMHistory

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

ICD-9-CM
375.61 Lacrimal fistula
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 H04.613Overview

Is H04.613 (Lacrimal fistula) a billable code?

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

What MS-DRG does H04.613 group to?

When lacrimal fistula bilateral lacrimal passages 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 H04.613?

Under the General Equivalence Mappings, lacrimal fistula bilateral lacrimal passages converts to ICD-9-CM 375.61 (lacrimal fistula). 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.