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ICD-10 Guide
ICD-10 CodesH02.003

H02.003

Billable

Unspecified entropion of right eye, unspecified eyelid

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

Code Description

ICD-10 H02.003 is a billable code used to indicate a diagnosis of unspecified entropion of right eye, unspecified eyelid.

Key Diagnostic Point:

Entropion is a condition characterized by the inward turning of the eyelid, which can lead to irritation of the cornea and conjunctiva due to the eyelashes rubbing against the eye. In the case of unspecified entropion of the right eye, the specific eyelid affected is not identified, which can complicate diagnosis and treatment. The anatomy involved includes the eyelid structures, such as the tarsal plate, orbicularis oculi muscle, and the conjunctiva. Disease progression can vary, with symptoms ranging from mild irritation to severe discomfort and potential vision impairment if left untreated. Diagnostic considerations include a thorough ocular examination to assess eyelid position, corneal health, and any associated conditions such as dry eye or blepharitis. Treatment options may involve conservative measures like lubricating eye drops or surgical intervention to correct the eyelid position. Accurate diagnosis and coding are essential for effective management and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive ocular examination and differentiation from other eyelid disorders.
  • Treatment complexity: May involve both conservative and surgical options depending on severity.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis and treatment plan.
  • Coding specificity: Unspecified nature of the code may lead to ambiguity in clinical documentation.

Audit Risk Factors

  • Common coding errors: Misidentification of the eyelid affected can lead to incorrect coding.
  • Documentation gaps: Incomplete clinical notes may result in denials or audits.
  • Billing challenges: Lack of specificity may complicate reimbursement processes.

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

Optometry

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

The clinical significance of H02.003 lies in its potential to cause discomfort and vision impairment if untreated. Population health impact includes the prevalence of eyelid disorders, which can affect quality of life and increase healthcare utilization. Quality measures may focus on timely diagnosis and treatment of eyelid conditions to prevent complications. Epidemiologically, entropion is more common in older adults, highlighting the need for awareness and appropriate management in this demographic.

ICD-9 vs ICD-10

The clinical significance of H02.003 lies in its potential to cause discomfort and vision impairment if untreated. Population health impact includes the prevalence of eyelid disorders, which can affect quality of life and increase healthcare utilization. Quality measures may focus on timely diagnosis and treatment of eyelid conditions to prevent complications. Epidemiologically, entropion is more common in older adults, highlighting the need for awareness and appropriate management in this demographic.

Reimbursement & Billing Impact

reimbursement issues. Familiarity with payer-specific guidelines can also enhance billing accuracy.

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 H02.003?

H02.003 covers unspecified entropion of the right eye, which may include cases where the specific eyelid (upper or lower) is not documented. It is essential to differentiate this from other eyelid disorders such as ectropion or blepharospasm.

When should H02.003 be used instead of related codes?

H02.003 should be used when the specific eyelid affected is not documented. If the upper or lower eyelid is specified, the corresponding codes H02.001 or H02.002 should be used instead.

What documentation supports H02.003?

Documentation should include a detailed ocular examination report, noting the presence of entropion, symptoms experienced by the patient, and any treatment provided. Photographic evidence may also support the diagnosis.