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ICD-10 Guide
ICD-10 CodesH01.124

H01.124

Billable

Discoid lupus erythematosus of left upper eyelid

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

Code Description

ICD-10 H01.124 is a billable code used to indicate a diagnosis of discoid lupus erythematosus of left upper eyelid.

Key Diagnostic Point:

Discoid lupus erythematosus (DLE) of the left upper eyelid is a chronic autoimmune condition characterized by well-defined, erythematous plaques with adherent scales that can lead to scarring and atrophy of the eyelid skin. Clinically, patients may present with localized lesions that can be asymptomatic or associated with pruritus. The left upper eyelid is particularly susceptible due to its exposure to sunlight, which can exacerbate the condition. The periocular anatomy includes the eyelid skin, conjunctiva, and surrounding structures, all of which can be affected by DLE. Disease progression may lead to complications such as eyelid malposition, scarring, and potential vision impairment if the lesions extend to the cornea. Diagnostic considerations include a thorough clinical examination, patient history, and, if necessary, a skin biopsy to confirm the diagnosis. Laboratory tests may also be conducted to assess for systemic lupus erythematosus (SLE) and other autoimmune markers, as DLE can be associated with systemic disease.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and possibly biopsy for confirmation.
  • Treatment complexity: Management may involve topical corticosteroids, immunomodulators, or referral to dermatology.
  • Documentation requirements: Detailed documentation of clinical findings, treatment plans, and follow-up is essential.
  • Coding specificity: Requires precise coding to differentiate from other forms of lupus and eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the eyelid location or confusion with other lupus codes.
  • Documentation gaps: Incomplete patient history or lack of biopsy results can lead to coding inaccuracies.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: 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

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of H01.124 lies in its potential to affect the quality of life of patients due to cosmetic concerns and possible vision impairment. Population health impact includes the need for awareness and early diagnosis to prevent complications. Quality measures may focus on timely referrals to specialists and effective management strategies. Epidemiologically, discoid lupus erythematosus is more prevalent in certain demographics, necessitating targeted healthcare resources and education.

ICD-9 vs ICD-10

The clinical significance of H01.124 lies in its potential to affect the quality of life of patients due to cosmetic concerns and possible vision impairment. Population health impact includes the need for awareness and early diagnosis to prevent complications. Quality measures may focus on timely referrals to specialists and effective management strategies. Epidemiologically, discoid lupus erythematosus is more prevalent in certain demographics, necessitating targeted healthcare resources and education.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the documentation aligns with the diagnosis and treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures performed. Best practices include maintaining thorough records of clinical findings, treatment responses, and follow-up care to substantiate claims and reduce the risk of audits.

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 H01.124?

H01.124 specifically covers discoid lupus erythematosus localized to the left upper eyelid. It is characterized by chronic skin lesions that may present with erythema, scaling, and potential scarring.

When should H01.124 be used instead of related codes?

H01.124 should be used when the condition specifically affects the left upper eyelid, distinguishing it from other eyelid disorders or DLE affecting different locations.

What documentation supports H01.124?

Documentation should include a detailed clinical examination, patient history, treatment plans, and any biopsy results that confirm the diagnosis of discoid lupus erythematosus.