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ICD-10 Guide
ICD-10 CodesH02.013

H02.013

Billable

Cicatricial entropion of right eye, unspecified eyelid

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

Code Description

ICD-10 H02.013 is a billable code used to indicate a diagnosis of cicatricial entropion of right eye, unspecified eyelid.

Key Diagnostic Point:

Cicatricial entropion of the right eye, unspecified eyelid, is characterized by an inward turning of the eyelid margin due to scarring or fibrosis. This condition can lead to irritation of the cornea and conjunctiva, resulting in symptoms such as redness, tearing, and discomfort. The eyelid anatomy involved includes the skin, muscle, and connective tissue, which may be affected by trauma, surgery, or inflammatory diseases. Disease progression can vary; if left untreated, cicatricial entropion can lead to corneal abrasions, infections, and potentially vision loss. Diagnostic considerations include a thorough patient history, physical examination, and possibly imaging studies to assess the extent of scarring and any associated conditions. Treatment options may include surgical intervention to correct the eyelid position and address the underlying scarring, as well as symptomatic management to alleviate discomfort.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful evaluation of eyelid anatomy and function.
  • Treatment complexity: Surgical options may be necessary, requiring coordination with ophthalmology.
  • Documentation requirements: Detailed clinical notes are essential to support the diagnosis.
  • Coding specificity: Accurate coding is crucial to differentiate from other types of entropion.

Audit Risk Factors

  • Common coding errors: Misidentification of the eye involved or type of entropion.
  • Documentation gaps: Insufficient detail in clinical notes regarding the cause and symptoms.
  • Billing challenges: Potential denials if the medical necessity for surgery is not clearly documented.

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 due 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 inflammatory diseases. Effective management can reduce healthcare utilization by preventing complications such as corneal ulcers, thereby improving overall patient outcomes and quality measures.

ICD-9 vs ICD-10

Cicatricial entropion can significantly impact a patient's quality of life due 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 inflammatory diseases. Effective management can reduce healthcare utilization by preventing complications such as corneal ulcers, thereby improving overall patient outcomes and quality measures.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure and the patient's overall health status. Common denials may arise from insufficient documentation or lack of clear medical necessity. Best practices include maintaining detailed clinical notes, obtaining pre-authorization when necessary, and ensuring that all coding aligns with the documented diagnosis and treatment plan.

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 H02.013?

H02.013 covers cicatricial entropion specifically affecting the right eyelid, which may result from trauma, surgery, or inflammatory conditions leading to scarring. It is important to differentiate this from other forms of entropion, such as involutional or spastic entropion.

When should H02.013 be used instead of related codes?

H02.013 should be used when the diagnosis specifically indicates cicatricial entropion of the right eyelid. If the condition affects the left eyelid or is of a different etiology, other codes such as H02.012 or H02.019 should be considered.

What documentation supports H02.013?

Documentation should include a detailed history of the onset of symptoms, any previous surgeries or trauma to the eyelid, and a comprehensive eye examination noting the eyelid's position and any associated corneal findings.