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ICD-10 Guide
ICD-10 CodesH01.126

H01.126

Billable

Discoid lupus erythematosus of left eye, unspecified eyelid

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

Code Description

ICD-10 H01.126 is a billable code used to indicate a diagnosis of discoid lupus erythematosus of left eye, unspecified eyelid.

Key Diagnostic Point:

Discoid lupus erythematosus (DLE) is a chronic autoimmune condition characterized by the presence of disc-shaped lesions primarily affecting the skin, but it can also involve the eyelids. In the case of H01.126, the condition specifically affects the left eyelid, which may present with erythematous plaques, scaling, and potential scarring. The eyelid anatomy includes the skin, muscles, and connective tissue, which can be compromised by the inflammatory process of DLE. The disease progression can lead to complications such as eyelid malposition, which may affect vision and ocular health. Diagnosis typically involves a thorough clinical examination, patient history, and may include a biopsy of the affected area to confirm the diagnosis. The condition is often associated with systemic lupus erythematosus (SLE), and thus, a comprehensive evaluation for systemic involvement is essential. Treatment may involve topical corticosteroids, immunosuppressive agents, and sun protection measures to manage symptoms and prevent exacerbation. Understanding the periocular anatomy and the implications of DLE on eyelid function is crucial for effective management and patient education.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other eyelid disorders such as seborrheic dermatitis or squamous cell carcinoma.
  • Treatment complexity: Involves a multidisciplinary approach including dermatology and ophthalmology.
  • Documentation requirements: Requires detailed clinical notes and possibly histopathological reports.
  • Coding specificity: Specific to left eyelid involvement, necessitating precise documentation.

Audit Risk Factors

  • Common coding errors: Misidentification of the condition as a non-specific eyelid dermatitis.
  • Documentation gaps: Incomplete patient history or lack of biopsy results.
  • Billing challenges: Potential denials if the link between DLE and eyelid involvement is not clearly established.

Specialty Focus

Medical Specialties

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

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

Discoid lupus erythematosus can significantly impact patients' quality of life, particularly when it affects visible areas such as the eyelids. The condition may lead to psychological distress due to cosmetic concerns and functional impairment. Understanding the epidemiology of DLE, particularly in populations with a higher prevalence of autoimmune disorders, can inform public health strategies and improve patient outcomes. Quality measures focusing on early diagnosis and effective management can enhance healthcare utilization patterns and reduce complications associated with this condition.

ICD-9 vs ICD-10

Discoid lupus erythematosus can significantly impact patients' quality of life, particularly when it affects visible areas such as the eyelids. The condition may lead to psychological distress due to cosmetic concerns and functional impairment. Understanding the epidemiology of DLE, particularly in populations with a higher prevalence of autoimmune disorders, can inform public health strategies and improve patient outcomes. Quality measures focusing on early diagnosis and effective management can enhance healthcare utilization patterns and reduce complications associated with this condition.

Reimbursement & Billing Impact

reimbursement. Additionally, understanding payer-specific guidelines can help mitigate billing challenges.

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 H01.126?

H01.126 specifically covers discoid lupus erythematosus affecting the left eyelid. It is characterized by chronic, disc-shaped lesions that can lead to scarring and functional impairment of the eyelid.

When should H01.126 be used instead of related codes?

H01.126 should be used when the clinical presentation is consistent with discoid lupus erythematosus localized to the left eyelid, differentiating it from other eyelid conditions such as eczema or basal cell carcinoma.

What documentation supports H01.126?

Documentation should include a detailed clinical examination, patient history, and any laboratory or biopsy results confirming the diagnosis of discoid lupus erythematosus affecting the eyelid.