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ICD-10 Guide
ICD-10 CodesH01.012

H01.012

Billable

Ulcerative blepharitis right lower eyelid

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

Code Description

ICD-10 H01.012 is a billable code used to indicate a diagnosis of ulcerative blepharitis right lower eyelid.

Key Diagnostic Point:

Ulcerative blepharitis is an inflammatory condition affecting the eyelid margins, characterized by the presence of crusting, scaling, and ulceration. The right lower eyelid is specifically involved in this code. The condition often results from seborrheic dermatitis, staphylococcal infection, or meibomian gland dysfunction, leading to irritation and inflammation. Clinically, patients may present with symptoms such as redness, itching, burning, and discharge from the affected eyelid. The periocular anatomy includes the eyelids, conjunctiva, and surrounding tissues, which can all be impacted by the inflammatory process. Disease progression can lead to complications such as eyelash loss, scarring, or chronic conjunctivitis if left untreated. Diagnostic considerations include a thorough history and physical examination, often supplemented by cultures or scrapings to identify underlying infectious agents. Treatment typically involves eyelid hygiene, topical antibiotics, and anti-inflammatory medications, 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 and medications.
  • Documentation requirements: Requires detailed clinical notes to support diagnosis and treatment.
  • Coding specificity: Specific to ulcerative blepharitis of the right lower eyelid, necessitating accurate coding.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected eyelid or misclassification of the type of blepharitis.
  • Documentation gaps: Incomplete clinical notes that do not specify the ulcerative nature or location.
  • Billing challenges: Potential denials if the 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 affect a patient's quality of life, leading to discomfort and potential vision issues if not managed properly. The condition is prevalent in various populations, particularly among those with underlying skin conditions. Effective management can reduce healthcare utilization by minimizing complications and the need for more invasive procedures. Understanding the epidemiology of blepharitis can help healthcare providers implement preventive measures and improve patient outcomes.

ICD-9 vs ICD-10

Ulcerative blepharitis can significantly affect a patient's quality of life, leading to discomfort and potential vision issues if not managed properly. The condition is prevalent in various populations, particularly among those with underlying skin conditions. Effective management can reduce healthcare utilization by minimizing complications and the need for more invasive procedures. Understanding the epidemiology of blepharitis can help healthcare providers implement preventive measures and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear evidence of the ulcerative nature of the blepharitis and the specific eyelid involved. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the treatments rendered. Best practices include maintaining thorough clinical notes and ensuring that all services billed are supported by the patient's clinical presentation and treatment plan.

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 H01.012?

H01.012 specifically covers ulcerative blepharitis affecting the right lower eyelid. This includes conditions characterized by inflammation, crusting, and ulceration of the eyelid margin, often associated with bacterial infections or seborrheic dermatitis.

When should H01.012 be used instead of related codes?

H01.012 should be used when the clinical presentation specifically indicates ulcerative blepharitis localized to the right lower eyelid. It is important to differentiate from other types of blepharitis or eyelid conditions that may not involve ulceration.

What documentation supports H01.012?

Documentation should include a detailed clinical examination noting the presence of ulceration, inflammation, and any associated symptoms. Additionally, treatment plans and follow-up notes should be clearly outlined to support the diagnosis.