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ICD-10 Guide
ICD-10 CodesH01.026

H01.026

Billable

Squamous blepharitis left eye, unspecified eyelid

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

Code Description

ICD-10 H01.026 is a billable code used to indicate a diagnosis of squamous blepharitis left eye, unspecified eyelid.

Key Diagnostic Point:

H01.026 refers to squamous blepharitis affecting the left eye, specifically the unspecified eyelid. This condition is characterized by inflammation of the eyelid margins, often resulting in crusting, redness, and irritation. The squamous type of blepharitis is typically associated with seborrheic dermatitis or staphylococcal infections, leading to the accumulation of scales and debris on the eyelid. The eyelid anatomy involved includes the skin, meibomian glands, and hair follicles, which can become obstructed or inflamed. Disease progression may lead to chronic discomfort, potential eyelash loss, and secondary infections if left untreated. Diagnostic considerations include a thorough history and physical examination, often supplemented by slit-lamp examination to assess the extent of eyelid involvement and rule out other conditions such as meibomian gland dysfunction or allergic reactions. Treatment typically involves eyelid hygiene, warm compresses, and topical antibiotics or corticosteroids as necessary.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other forms of blepharitis and ocular surface diseases.
  • Treatment complexity: May involve multiple treatment modalities and patient compliance.
  • Documentation requirements: Detailed clinical notes are necessary to support diagnosis and treatment.
  • Coding specificity: Requires precise coding to reflect the affected eye and type of blepharitis.

Audit Risk Factors

  • Common coding errors: Misidentifying the affected eyelid or type of blepharitis.
  • Documentation gaps: Incomplete clinical notes that do not justify the diagnosis.
  • Billing challenges: Potential denials if the documentation does not clearly support the diagnosis.

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

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CPT Code

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Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of H01.026 lies in its potential to cause discomfort and impact the quality of life for affected individuals. Population health impact includes the prevalence of blepharitis in the general population, which can lead to increased healthcare utilization due to recurrent symptoms and complications. Quality measures may focus on the effectiveness of treatment protocols and patient adherence to eyelid hygiene practices, while epidemiological considerations highlight the need for awareness and education regarding eyelid disorders.

ICD-9 vs ICD-10

The clinical significance of H01.026 lies in its potential to cause discomfort and impact the quality of life for affected individuals. Population health impact includes the prevalence of blepharitis in the general population, which can lead to increased healthcare utilization due to recurrent symptoms and complications. Quality measures may focus on the effectiveness of treatment protocols and patient adherence to eyelid hygiene practices, while epidemiological considerations highlight the need for awareness and education regarding eyelid disorders.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is supported by clinical findings and that any procedures performed are appropriately coded. Common denials may occur if the documentation does not clearly establish the medical necessity for the treatment provided. Best practices include maintaining thorough clinical notes and ensuring that all relevant information is included in the billing submission to avoid delays in payment.

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 H01.026?

H01.026 specifically covers squamous blepharitis of the left eyelid, which may be associated with seborrheic dermatitis or staphylococcal infections. It does not cover other types of blepharitis, such as ulcerative or allergic blepharitis.

When should H01.026 be used instead of related codes?

H01.026 should be used when the condition specifically affects the left eyelid and is diagnosed as squamous blepharitis. It is important to differentiate it from other types of blepharitis or conditions affecting the eyelids.

What documentation supports H01.026?

Documentation should include a detailed history of symptoms, physical examination findings, and any diagnostic tests performed. Notes should clearly indicate the diagnosis of squamous blepharitis affecting the left eyelid.