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ICD-10 Guide
ICD-10 CodesH01.011

H01.011

Billable

Ulcerative blepharitis right upper eyelid

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

Code Description

ICD-10 H01.011 is a billable code used to indicate a diagnosis of ulcerative blepharitis right upper eyelid.

Key Diagnostic Point:

Ulcerative blepharitis is an inflammatory condition affecting the eyelid margins, characterized by crusting, redness, and ulceration. The right upper eyelid is specifically involved in this code. The condition often arises from seborrheic dermatitis, staphylococcal infection, or meibomian gland dysfunction. Clinically, patients may present with symptoms such as itching, burning, and foreign body sensation, along with visible scales and debris at the eyelid margins. The periocular anatomy includes the eyelids, eyelashes, and the lacrimal system, which plays a crucial role in tear production and drainage. Disease progression can lead to chronic inflammation, scarring, and potential complications such as conjunctivitis or keratitis if left untreated. Diagnostic considerations include a thorough history, physical examination, and possibly cultures or scrapings to identify infectious agents. Management typically involves eyelid hygiene, topical antibiotics, and anti-inflammatory agents, with the goal of alleviating symptoms and preventing recurrence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other eyelid disorders such as staphylococcal blepharitis or seborrheic dermatitis.
  • Treatment complexity: Involves multiple treatment modalities including hygiene measures, topical medications, and sometimes systemic therapy.
  • Documentation requirements: Detailed documentation of symptoms, treatment response, and follow-up care is essential.
  • Coding specificity: Requires precise coding to differentiate between types of blepharitis and the specific eyelid involved.

Audit Risk Factors

  • Common coding errors: Misidentifying the affected eyelid or failing to specify the type of blepharitis.
  • Documentation gaps: Incomplete records regarding treatment plans or follow-up assessments.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis and treatment provided.

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

Ulcerative blepharitis can significantly impact patient quality of life due to discomfort and potential vision impairment. It is essential for healthcare providers to recognize and treat this condition promptly to prevent complications. Understanding the epidemiology of blepharitis, including its prevalence in various populations, can inform public health strategies and improve patient outcomes.

ICD-9 vs ICD-10

Ulcerative blepharitis can significantly impact patient quality of life due to discomfort and potential vision impairment. It is essential for healthcare providers to recognize and treat this condition promptly to prevent complications. Understanding the epidemiology of blepharitis, including its prevalence in various populations, can inform public health strategies and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of eyelid hygiene instructions and any prescribed medications. Common denials may arise from insufficient documentation of the condition's severity or lack of follow-up care. Best practices include ensuring that all treatment plans are well-documented and that the medical necessity of services is clearly articulated in the patient's record.

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 H01.011?

H01.011 specifically covers ulcerative blepharitis affecting the right upper eyelid, which may be caused by bacterial infections, seborrheic dermatitis, or other inflammatory processes. It is characterized by ulceration and crusting at the eyelid margin.

When should H01.011 be used instead of related codes?

H01.011 should be used when the clinical presentation specifically involves ulcerative blepharitis of the right upper eyelid. It is important to differentiate it from other types of blepharitis or eyelid disorders that may not involve ulceration.

What documentation supports H01.011?

Documentation should include a detailed history of symptoms, physical examination findings, treatment plans, and any diagnostic tests performed. Evidence of ulceration and the specific eyelid affected must be clearly noted.