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ICD-10 Guide
ICD-10 CodesH01.004

H01.004

Billable

Unspecified blepharitis left upper eyelid

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

Code Description

ICD-10 H01.004 is a billable code used to indicate a diagnosis of unspecified blepharitis left upper eyelid.

Key Diagnostic Point:

H01.004 refers to unspecified blepharitis of the left upper eyelid, a common inflammatory condition affecting the eyelid margins. Clinically, patients may present with symptoms such as redness, swelling, crusting, and irritation of the eyelid. The condition can arise from various etiologies, including seborrheic dermatitis, staphylococcal infection, or meibomian gland dysfunction. Anatomically, the eyelids consist of skin, muscle, and connective tissue, with the eyelid margins housing the meibomian glands, which are crucial for tear film stability. Disease progression can lead to chronic inflammation, potential eyelash loss, and secondary infections if left untreated. Diagnostic considerations include a thorough patient history, physical examination, and possibly laboratory tests to rule out underlying conditions. Management typically involves eyelid hygiene, warm compresses, and topical antibiotics or anti-inflammatories as needed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires differentiation from other eyelid conditions.
  • Treatment complexity: Moderate, involving both conservative and potentially pharmacological interventions.
  • Documentation requirements: Moderate, necessitating detailed clinical notes and treatment plans.
  • Coding specificity: Medium, as it specifies the left upper eyelid but lacks further detail on the type of blepharitis.

Audit Risk Factors

  • Common coding errors: Misidentifying the eyelid affected or using a more specific code when unspecified is appropriate.
  • Documentation gaps: Lack of detailed clinical notes supporting the diagnosis.
  • Billing challenges: Potential denials if documentation does not clearly justify the need for treatment.

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

Dermatology

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

Blepharitis is a prevalent condition that can significantly affect patients' quality of life, leading to discomfort and potential complications such as conjunctivitis. Understanding its epidemiology is crucial, as it can impact healthcare utilization patterns, with many patients seeking care for associated symptoms. Quality measures may include patient education on eyelid hygiene and follow-up care, which can improve overall management and reduce recurrence rates.

ICD-9 vs ICD-10

Blepharitis is a prevalent condition that can significantly affect patients' quality of life, leading to discomfort and potential complications such as conjunctivitis. Understanding its epidemiology is crucial, as it can impact healthcare utilization patterns, with many patients seeking care for associated symptoms. Quality measures may include patient education on eyelid hygiene and follow-up care, which can improve overall management and reduce recurrence rates.

Reimbursement & Billing Impact

reimbursement and to ensure that all relevant codes are included in the claim to avoid billing issues.

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 H01.004?

H01.004 encompasses unspecified blepharitis affecting the left upper eyelid, which may include various forms of blepharitis such as seborrheic, staphylococcal, or meibomian gland dysfunction-related blepharitis, without specifying the exact cause.

When should H01.004 be used instead of related codes?

H01.004 should be used when the specific type of blepharitis affecting the left upper eyelid is not identified. If the type is known, a more specific code should be selected to ensure accurate representation of the patient's condition.

What documentation supports H01.004?

Documentation should include a detailed history of symptoms, physical examination findings, treatment plans, and any diagnostic tests performed. Clear notes on the location and nature of the blepharitis are essential for proper coding.