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ICD-10 Guide
ICD-10 CodesH02.012

H02.012

Billable

Cicatricial entropion of right lower eyelid

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

Code Description

ICD-10 H02.012 is a billable code used to indicate a diagnosis of cicatricial entropion of right lower eyelid.

Key Diagnostic Point:

Cicatricial entropion of the right lower eyelid is a condition characterized by the inward turning of the eyelid due to scarring. This can lead to irritation of the cornea and conjunctiva, resulting in symptoms such as redness, tearing, and discomfort. The condition often arises from previous trauma, surgery, or inflammatory diseases that cause scarring of the eyelid tissue. The anatomy involved includes the eyelid structures such as the skin, orbicularis oculi muscle, and the conjunctival lining. The disease progression can lead to chronic irritation and potential corneal damage if left untreated. Diagnostic considerations include a thorough clinical examination, patient history, and possibly imaging studies to assess the extent of scarring and any associated conditions. Treatment may involve surgical intervention to correct the eyelid position and alleviate symptoms, making early diagnosis and management crucial to prevent complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful assessment of eyelid anatomy and function.
  • Treatment complexity: May involve surgical procedures with varying degrees of invasiveness.
  • Documentation requirements: Detailed clinical notes and surgical reports are necessary.
  • Coding specificity: Requires precise coding to differentiate from other types of entropion.

Audit Risk Factors

  • Common coding errors: Misclassification with other eyelid disorders.
  • Documentation gaps: Incomplete records regarding the cause of cicatricial changes.
  • Billing challenges: Potential denials if the medical necessity is not clearly established.

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 affect a patient's quality of life due to discomfort and visual disturbances. Understanding its prevalence and management is vital for improving patient outcomes. Effective treatment can reduce healthcare utilization by preventing complications such as corneal abrasions or infections. Awareness of this condition contributes to better population health management and adherence to quality measures in ophthalmic care.

ICD-9 vs ICD-10

Cicatricial entropion can significantly affect a patient's quality of life due to discomfort and visual disturbances. Understanding its prevalence and management is vital for improving patient outcomes. Effective treatment can reduce healthcare utilization by preventing complications such as corneal abrasions or infections. Awareness of this condition contributes to better population health management and adherence to quality measures in ophthalmic care.

Reimbursement & Billing Impact

Cicatricial entropion can significantly affect a patient's quality of life due to discomfort and visual disturbances. Understanding its prevalence and management is vital for improving patient outcomes. Effective treatment can reduce healthcare utilization by preventing complications such as corneal abrasions or infections. Awareness of this condition contributes to better population health management and adherence to quality measures in ophthalmic care.

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 H02.012?

H02.012 specifically covers cicatricial entropion of the right lower eyelid, which is caused by scarring. It does not include other forms of entropion such as involutional or spastic entropion.

When should H02.012 be used instead of related codes?

H02.012 should be used when the entropion is specifically due to scarring of the right lower eyelid. If the entropion is due to other causes, such as age-related changes, different codes should be selected.

What documentation supports H02.012?

Documentation should include a detailed history of the patient's eyelid condition, clinical findings from the examination, and any relevant imaging studies that support the diagnosis of cicatricial entropion.