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ICD-10 Guide
ICD-10 CodesH02.005

H02.005

Billable

Unspecified entropion of left lower eyelid

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

Code Description

ICD-10 H02.005 is a billable code used to indicate a diagnosis of unspecified entropion of left lower eyelid.

Key Diagnostic Point:

Unspecified entropion of the left lower eyelid is characterized by the inward turning of the eyelid margin, which can lead to irritation of the conjunctiva and cornea due to the eyelashes rubbing against the ocular surface. This condition can result from various factors, including age-related changes, scarring, or congenital anomalies. The anatomy involved includes the eyelid, which consists of skin, muscle, and connective tissue, as well as the underlying conjunctiva and lacrimal system, which are crucial for tear production and drainage. Disease progression may lead to chronic irritation, corneal abrasions, and potentially vision impairment if left untreated. Diagnostic considerations include a thorough clinical examination, patient history, and possibly imaging studies to assess the extent of the entropion and any associated conditions. Treatment options may vary from conservative management, such as lubricating eye drops, to surgical intervention to correct the eyelid position.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as entropion can be secondary to various underlying conditions.
  • Treatment complexity: Moderate, with options ranging from non-invasive to surgical interventions.
  • Documentation requirements: Requires detailed clinical notes to support diagnosis and treatment.
  • Coding specificity: Moderate, as it is important to specify the location and type of entropion.

Audit Risk Factors

  • Common coding errors: Misidentification of the eyelid location or type of entropion.
  • Documentation gaps: Lack of detailed clinical findings or treatment rationale.
  • Billing challenges: Potential denials if 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

Plastic Surgery

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 H02.005 lies in its potential to cause discomfort and visual impairment if untreated. Population health impact includes the prevalence of eyelid disorders, which can affect quality of life and necessitate healthcare interventions. Quality measures may focus on timely diagnosis and treatment to prevent complications. Understanding healthcare utilization patterns related to entropion can help in resource allocation and improving patient outcomes, particularly in aging populations where this condition is more common.

ICD-9 vs ICD-10

The clinical significance of H02.005 lies in its potential to cause discomfort and visual impairment if untreated. Population health impact includes the prevalence of eyelid disorders, which can affect quality of life and necessitate healthcare interventions. Quality measures may focus on timely diagnosis and treatment to prevent complications. Understanding healthcare utilization patterns related to entropion can help in resource allocation and improving patient outcomes, particularly in aging populations where this condition is more common.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the procedure codes align with the diagnosis and that all necessary clinical information is included to avoid denials. Common denials may occur if the documentation does not clearly establish the medical necessity of the treatment provided. Best practices include using precise coding, maintaining thorough clinical notes, and ensuring that all services rendered are justified by the patient's clinical condition.

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 H02.005?

H02.005 covers unspecified entropion of the left lower eyelid, which may arise from various causes including age-related changes, scarring, or congenital factors. It is important to differentiate it from other eyelid disorders such as ectropion or blepharospasm.

When should H02.005 be used instead of related codes?

H02.005 should be used when the specific type of entropion is not documented, or when the clinical presentation does not fit other specific codes. It is essential to ensure that the documentation supports the unspecified nature of the diagnosis.

What documentation supports H02.005?

Documentation should include a detailed clinical examination, patient history, and any relevant imaging studies. Notes should clearly describe the symptoms, the extent of the entropion, and any treatment provided.