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ICD-10 Guide
ICD-10 CodesH04.121

H04.121

Billable

Dry eye syndrome of right lacrimal gland

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 H04.121 is a billable code used to indicate a diagnosis of dry eye syndrome of right lacrimal gland.

Key Diagnostic Point:

Dry eye syndrome of the right lacrimal gland is characterized by insufficient tear production or excessive tear evaporation, leading to ocular discomfort and potential damage to the ocular surface. The lacrimal gland, located in the upper outer region of the orbit, is responsible for producing tears that lubricate the eye. In dry eye syndrome, inflammation of the lacrimal gland can occur, resulting in symptoms such as dryness, burning, and a gritty sensation in the eye. The condition may progress to more severe ocular surface disease if left untreated, potentially leading to complications such as corneal abrasions or infections. Diagnosis typically involves a comprehensive eye examination, including tear break-up time tests and Schirmer's test to assess tear production. Treatment options may include artificial tears, anti-inflammatory medications, and in some cases, punctal plugs to retain tears on the ocular surface. Understanding the anatomy of the lacrimal system and the role of the eyelids in tear distribution is crucial for effective management of this condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough assessment of symptoms and potential underlying causes.
  • Treatment complexity: May involve multiple treatment modalities and patient education.
  • Documentation requirements: Detailed documentation of symptoms, diagnostic tests, and treatment plans is essential.
  • Coding specificity: Requires precise coding to differentiate from other lacrimal gland disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected eye or incorrect use of related codes.
  • Documentation gaps: Incomplete records of symptoms or treatment plans may lead to denials.
  • Billing challenges: Variability in insurance coverage for treatments may complicate reimbursement.

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Primary care

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Dry eye syndrome significantly affects quality of life, leading to decreased productivity and increased healthcare utilization. It is prevalent among older adults and can be exacerbated by environmental factors and certain medications. Understanding its epidemiology helps in developing targeted interventions and quality measures to improve patient outcomes and reduce the burden on healthcare systems.

ICD-9 vs ICD-10

Dry eye syndrome significantly affects quality of life, leading to decreased productivity and increased healthcare utilization. It is prevalent among older adults and can be exacerbated by environmental factors and certain medications. Understanding its epidemiology helps in developing targeted interventions and quality measures to improve patient outcomes and reduce the burden on healthcare systems.

Reimbursement & Billing Impact

Reimbursement may vary based on the insurance provider's policies regarding dry eye treatments. Common denials can occur if documentation does not clearly support the diagnosis or if the treatment is deemed not medically necessary. It is crucial to ensure that all relevant tests and evaluations are documented to substantiate the medical necessity of the services provided.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for H00-H99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for H00-H99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by H04.121?

H04.121 specifically covers dry eye syndrome affecting the right lacrimal gland, which may be due to various factors including age, environmental conditions, or systemic diseases such as Sjögren's syndrome.

When should H04.121 be used instead of related codes?

H04.121 should be used when the clinical assessment confirms dry eye syndrome localized to the right lacrimal gland, distinguishing it from other conditions like conjunctivitis or dry eye syndrome affecting the left side.

What documentation supports H04.121?

Documentation should include a detailed patient history, symptom assessment, results from diagnostic tests such as tear production tests, and a treatment plan outlining the management of dry eye syndrome.