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  • How to Code for Infant Nasal Lacrimal Duct Obstruction


    Question: Depending upon the payer, we receive denials for infants with nasal lacrimal duct obstruction. Is there one ICD-10 code that fits all payers’ requirements?

    Answer: . Unfortunately not one diagnosis fits all payers. From the Coding Coach, Complete Ophthalmic Reference, consider any/all of the following.

    • H04.011  Acute dacryoadenitis, right lacrimal gland
    • H04.012  Acute dacryoadenitis, left lacrimal gland
    • H04.013  Acute dacryoadenitis, bilateral lacrimal glands
    • H04.021  Chronic dacryoadenitis, right lacrimal gland
    • H04.022  Chronic dacryoadenitis, left lacrimal gland
    • H04.023  Chronic dacryoadenitis, bilateral lacrimal glands
    • H04.121  Dry eye syndrome of right lacrimal gland
    • H04.122  Dry eye syndrome of left lacrimal gland
    • H04.123  Dry eye syndrome of bilateral lacrimal glands
    • H04.211  Epiphora due to excess lacrimation, right lacrimal gland
    • H04.212  Epiphora due to excess lacrimation, left lacrimal gland
    • H04.213  Epiphora due to excess lacrimation, bilateral lacrimal glands
    • H04.221  Epiphora due to insufficient drainage, right lacrimal gland
    • H04.222  Epiphora due to insufficient drainage, left lacrimal gland
    • H04.223  Epiphora due to insufficient drainage, bilateral lacrimal glands
    • H04.311  Phlegmonous dacryocystitis of right lacrimal passage
    • H04.312  Phlegmonous dacryocystitis of left lacrimal passage
    • H04.313  Phlegmonous dacryocystitis of bilateral lacrimal passages
    • H04.321  Acute dacryocystitis of right lacrimal passage (dacryopericystitis)
    • H04.322  Acute dacryocystitis of left lacrimal passage (dacryopericystitis)
    • H04.323  Acute dacryocystitis of bilateral lacrimal passages (dacryopericystitis)
    • H04.331  Acute lacrimal canaliculitis of right lacrimal passage
    • H04.332  Acute lacrimal canaliculitis of left lacrimal passage
    • H04.333  Acute lacrimal canaliculitis of bilateral lacrimal passages
    • H04.411  Chronic dacryocystitis of right lacrimal passage
    • H04.412  Chronic dacryocystitis of left lacrimal passage
    • H04.413  Chronic dacryocystitis of bilateral lacrimal passages
    • H04.431  Chronic lacrimal mucocele of right lacrimal passage
    • H04.432  Chronic lacrimal mucocele of left lacrimal passage
    • H04.433  Chronic lacrimal mucocele of bilateral lacrimal passages
    • H04.511  Dacryolith of right lacrimal passage
    • H04.512  Dacryolith of left lacrimal passage
    • H04.513  Dacryolith of bilateral lacrimal passages
    • H04.531  Neonatal obstruction of right nasolacrimal duct, Excludes1: congenital stenosis and stricture of lacrimal duct (Q10.5)
    • H04.532  Neonatal obstruction of left nasolacrimal duct, Excludes1: congenital stenosis and stricture of lacrimal duct (Q10.5)
    • H04.533  Neonatal obstruction of bilateral nasolacrimal duct, Excludes1: congenital stenosis and stricture of lacrimal duct (Q10.5)
    • H04.541  Stenosis of right lacrimal canaliculi
    • H04.542  Stenosis of left lacrimal canaliculi
    • H04.543  Stenosis of bilateral lacrimal canaliculi
    • H04.551  Acquired stenosis of right nasolacrimal duct
    • H04.552  Acquired stenosis of left nasolacrimal duct
    • H04.553  Acquired stenosis of bilateral nasolacrimal duct
    • H04.561  Stenosis of right lacrimal punctum
    • H04.562  Stenosis of left lacrimal punctum
    • H04.563  Stenosis of bilateral lacrimal punctum
    • H04.571  Stenosis of right lacrimal sac
    • H04.572  Stenosis of left lacrimal sac
    • H04.573  Stenosis of bilateral lacrimal punctum
    • H04.611  Lacrimal fistula right lacrimal passage
    • H04.612  Lacrimal fistula left lacrimal passage
    • H04.613  Lacrimal fistula bilateral lacrimal passages
    • H04.811  Granuloma of right lacrimal passage
    • H04.812  Granuloma of left lacrimal passage
    • H04.813  Granuloma of bilateral lacrimal passages
    • Q10.4  Absence and agenesis of lacrimal apparatus
    • Q10.5  Congenital stenosis and stricture of lacrimal duct
    • Q10.6  Other congenital malformations of lacrimal apparatus

    Remember, if payers covered the diagnosis in ICD-9, they should cover the ICD-10 cross-walk as well.