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ICD-10-CM 2027 diagnosis code

H04.221Epiphora due to insufficient drainage, right side

✓ Billable / specific

H04.221 is a valid, billable ICD-10-CM code for epiphora due to insufficient drainage, right side. It can be reported on claims for dates of service from October 1, 2026 – September 30, 2027.

Code last changed in FY2019 (effective October 1, 2018). Source: official FY2027 ICD-10-CM release from CDC/NCHS and CMS. Page updated September 29, 2026. About our data

About H04.221

H04.221 is the ICD-10-CM diagnosis code for epiphora due to insufficient drainage, right side. It belongs to category H04 (disorders of lacrimal system), block H00-H05 (disorders of eyelid, lacrimal system and orbit) and chapter 7 (diseases of the eye and adnexa). It is billable, so it can be reported on its own for dates of service from October 1, 2026 through September 30, 2027.

Within H04.22 (epiphora due to insufficient drainage), H04.221 is specifically for epiphora due to insufficient drainage, right side. Related codes cover left side (H04.222), bilateral (H04.223) and unspecified side (H04.229).

It is not a CC or MCC, so as a secondary diagnosis it doesn't change the MS-DRG severity level.

In MS-DRG v44.0, it is part of the grouping logic for DRG 124 (Other Disorders of the Eye with MCC or Thrombolytic Agent, relative weight 1.2471) and DRG 125 (Other Disorders of the Eye without MCC, relative weight 0.7702), in MDC 02 (Diseases and Disorders of the Eye), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.

It has been part of ICD-10-CM since the code set took effect on October 1, 2015, and changed in FY2019 (title revised).

Before ICD-10, this condition was coded in ICD-9-CM as 375.22 (epiphora due to insufficient drainage).

Notes that apply from higher levels

Instructions written at a parent level also apply to H04.221.

› From H04 Disorders of lacrimal system
Excludes1
  • congenital malformations of lacrimal system (Q10.4-Q10.6)

Broader instructions also apply from H00-H05 Disorders of eyelid, lacrimal system and orbit and Chapter 7: Diseases of the eye and adnexa.

MS-DRG v44.0 grouping

All DRGs →

Inpatient MS-DRGs this diagnosis can group to, as the principal or a secondary diagnosis, depending on the rest of the claim.

ICD-9-CM equivalent

Converter →
  • 375.22Epiphora due to insufficient drainageapproximate

From the CMS 2018 General Equivalence Mappings (GEMs), the final GEMs release.

Code history

  1. 2016
  2. 2017
  3. 2018
  4. 2019
  5. 2020
  6. 2021
  7. 2022
  8. 2023
  9. 2024
  10. 2025
  11. 2026
  12. 2027
  • FY2016 (effective 10/1/2015): Added (first year of ICD-10-CM)
  • FY2019 (effective 10/1/2018): Title revised — was “Epiphora due to insufficient drainage, right lacrimal gland”

Common questions about H04.221

Is H04.221 billable?

Yes. H04.221 is a billable/specific ICD-10-CM code valid for FY2027 (October 1, 2026 – September 30, 2027).

Can H04.221 be used as a principal diagnosis?

Yes. The Medicare Code Editor doesn't restrict H04.221 as a principal diagnosis.

Is H04.221 a CC or MCC?

No. H04.221 is neither a CC nor an MCC under MS-DRG v44.0.

What DRG does H04.221 group to?

H04.221 is used in the MS-DRG v44.0 logic for MS-DRG 124 (Other Disorders of the Eye with MCC or Thrombolytic Agent) and MS-DRG 125 (Other Disorders of the Eye without MCC). Which one applies depends on whether it is the principal diagnosis and on the rest of the claim.

What is the ICD-9 code for H04.221?

The CMS General Equivalence Mappings map H04.221 to ICD-9-CM 375.22.