ICD-10 Code H04.61 – Lacrimal fistula (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code H04.61 – Lacrimal fistula
What it is
H04.61 identifies an abnormal fistulous opening involving the lacrimal drainage system. Use it when documentation shows a tear-duct or lacrimal sac fistula, not a general eye discharge problem.
Clinical signs
Typical findings include a visible tract or opening near the medial canthus with tearing or drainage from the area. Clinical features vary; refer to documentation.
When to use this code
Use this code when the provider documents a lacrimal fistula, including congenital or acquired fistulous communication of the tear drainage pathway. It may appear after infection, trauma, or surgery, but you should code only what is clearly stated. Check documentation if the site or laterality is unclear.
Do not use for
Do not use H04.61 for simple epiphora, dacryocystitis, or blocked tear ducts without a fistula. If the record describes another lacrimal disorder, select the more specific diagnosis.
Coding tip
Confirm that the word “fistula” is documented; a draining eye alone does not support this code.