ICD-10 Code H04.613 – Lacrimal fistula bilateral lacrimal passages (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code H04.613 – Lacrimal fistula bilateral lacrimal passages
What it is
This code identifies an abnormal fistulous opening involving both lacrimal passages. It means tears or drainage can pass through an unintended tract rather than the normal tear drainage pathway.
Clinical signs
Clinical features vary; refer to documentation. Common findings may include chronic tearing, visible drainage near the inner eye area, or a persistent opening connected to the lacrimal system.
When to use this code
Use this code when the provider documents a fistula affecting both lacrimal passages. It may apply after trauma, surgery, infection, or other documented causes if the record clearly states bilateral involvement.
If the note only mentions a lacrimal fistula without laterality, check documentation before coding. You should not assume bilateral disease unless the provider explicitly documents it.
Do not use for
Do not use this code for simple tearing, blocked tear ducts, or a fistula involving only one side. If the record is unclear, check documentation.
Coding tip
Confirm both laterality and the term “fistula” in the provider note before assigning H04.613.