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ICD-10 Guide
ICD-10 CodesH02.011

H02.011

Billable

Cicatricial entropion of right upper eyelid

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

Code Description

ICD-10 H02.011 is a billable code used to indicate a diagnosis of cicatricial entropion of right upper eyelid.

Key Diagnostic Point:

Cicatricial entropion of the right upper eyelid is a condition characterized by the inward turning of the eyelid margin due to scarring or fibrosis. This condition can lead to irritation, corneal abrasion, and potential vision loss if left untreated. The upper eyelid anatomy includes the skin, muscle (orbicularis oculi), and connective tissue, all of which can be affected by cicatricial changes. Common causes of cicatricial entropion include trauma, surgery, or inflammatory conditions that result in scarring. Clinically, patients may present with symptoms such as redness, tearing, and discomfort, often exacerbated by exposure to environmental irritants. Diagnosis typically involves a thorough ocular examination, including assessment of eyelid position and corneal health. The progression of cicatricial entropion can vary; if the underlying cause is not addressed, the condition may worsen, leading to chronic irritation and complications. Treatment options may include surgical intervention to correct eyelid position and manage underlying scarring, alongside symptomatic relief measures. Accurate diagnosis and management are crucial to prevent further ocular complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a thorough understanding of eyelid anatomy and potential causes of scarring.
  • Treatment complexity: May involve surgical correction and management of underlying conditions.
  • Documentation requirements: Detailed clinical notes and history of the condition are necessary.
  • Coding specificity: Requires precise coding to differentiate from other forms of entropion.

Audit Risk Factors

  • Common coding errors: Misidentification of the type of entropion.
  • Documentation gaps: Incomplete patient history or lack of detailed examination notes.
  • Billing challenges: Potential denials due to insufficient documentation supporting 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

Cicatricial entropion can significantly impact a patient's quality of life, leading to discomfort and potential vision impairment. Understanding the epidemiology of this condition is crucial, as it may be more prevalent in populations with a history of trauma or certain inflammatory conditions. Effective management can improve patient outcomes and reduce healthcare utilization by preventing complications associated with untreated entropion.

ICD-9 vs ICD-10

Cicatricial entropion can significantly impact a patient's quality of life, leading to discomfort and potential vision impairment. Understanding the epidemiology of this condition is crucial, as it may be more prevalent in populations with a history of trauma or certain inflammatory conditions. Effective management can improve patient outcomes and reduce healthcare utilization by preventing complications associated with untreated entropion.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the case and the procedures performed. Common denials may arise from insufficient documentation or incorrect coding. To mitigate these risks, coders should ensure that the medical necessity for the procedure is clearly documented and that all relevant codes are accurately reported.

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 H02.011?

H02.011 specifically covers cicatricial entropion of the right upper eyelid, which is caused by scarring. It is important to differentiate this from other types of entropion, such as involutional or spastic entropion.

When should H02.011 be used instead of related codes?

H02.011 should be used when the entropion is specifically due to cicatricial changes of the right upper eyelid, as opposed to other forms of entropion which may have different underlying causes.

What documentation supports H02.011?

Documentation should include a detailed patient history, clinical examination findings, and any relevant imaging or diagnostic tests that confirm the diagnosis of cicatricial entropion.