2025 ICD-10-CM code H04.3
(Active) Effective Date: N/A Diseases of the eye and adnexa - Disorders of eyelid, lacrimal system and orbit 7 Feed
Acute and unspecified inflammation of the lacrimal passages (tear ducts). This includes inflammation of the lacrimal sac, but the cause is not specified.
Medical necessity for this code is established by the presence of signs and symptoms of acute inflammation in the lacrimal passages. Further investigation may be necessary to establish the underlying cause and guide treatment. Documentation should support the diagnosis and justify the need for medical intervention.
Diagnosis involves evaluating patient symptoms (pain, redness, swelling, pus/mucus in the eye's inner corner, watery eyes, fever), medical history, and a thorough eye examination. Additional tests may include imaging (dacryocystography or dacryoscintigraphy), fluorescein dye disappearance test, Schirmer's test (tear composition analysis), or nasal endoscopy, depending on the suspected cause. Treatment varies based on the severity and cause, ranging from antibiotics for bacterial infections to surgery for obstructions.
In simple words: This code refers to a recent or sudden swelling of the tear ducts, which are the small tubes that carry tears from your eyes to your nose. The exact cause of the swelling isn't specified.
Acute and unspecified inflammation of the lacrimal passages refers to swelling of the lacrimal channels (tear ducts) or lacrimal sac due to infection or injury. The provider does not document the type or cause of inflammation.
Example 1: A 35-year-old patient presents with pain, redness, and swelling in the inner corner of the left eye, along with pus discharge. The physician diagnoses acute inflammation of the lacrimal passages, but the underlying cause is not yet determined. H04.3 is used for billing., A 60-year-old patient experiences sudden swelling and tenderness near the tear duct, accompanied by excessive tearing.The doctor suspects acute inflammation, but further tests are needed to determine the cause. H04.3 is applied as the initial diagnosis code., A child presents with redness and swelling around the tear duct, and the eye is watering constantly. The pediatrician diagnoses acute inflammation of the lacrimal passage, without specifying the cause initially, and uses H04.3.
Documentation should include the type, laterality, and location of the inflammation, along with associated symptoms. Details of any diagnostic tests performed and their results are crucial. The treatment plan and patient's response to treatment should also be recorded.
** Excludes1: neonatal dacryocystitis (P39.1). Excludes2: certain conditions originating in the perinatal period (P04-P96), certain infectious and parasitic diseases (A00-B99), complications of pregnancy, childbirth, and the puerperium (O00-O9A), congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99), diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-), endocrine, nutritional and metabolic diseases (E00-E88), injury (trauma) of eye and orbit (S05.-), injury, poisoning and certain other consequences of external causes (S00-T88), neoplasms (C00-D49), symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94), syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71). Congenital malformations of lacrimal system (Q10.4-Q10.6) and open wound of eyelid (S01.1-) are also excluded.
- Specialties:Ophthalmology, Optometry
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Emergency Room - Hospital