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ICD-10 Guide
ICD-10 CodesH02.014

H02.014

Billable

Cicatricial entropion of left upper eyelid

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

Code Description

ICD-10 H02.014 is a billable code used to indicate a diagnosis of cicatricial entropion of left upper eyelid.

Key Diagnostic Point:

Cicatricial entropion of the left upper eyelid is a condition characterized by the inward turning of the eyelid margin due to scarring or fibrosis. This condition often results from previous trauma, surgery, or chronic inflammation that leads to the formation of scar tissue. The left upper eyelid is specifically affected, which can cause eyelashes to rub against the cornea, leading to irritation, discomfort, and potential vision impairment. The periocular anatomy involved includes the eyelid skin, conjunctiva, and the underlying orbicularis oculi muscle. Diagnosis typically involves a thorough clinical examination, including a visual acuity test and assessment of eyelid position and movement. Disease progression can lead to complications such as corneal abrasion or ulceration if left untreated. Treatment options may include surgical intervention to correct the eyelid position and alleviate symptoms, emphasizing the importance of timely diagnosis and management to prevent further ocular complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a detailed clinical examination and understanding of eyelid anatomy.
  • Treatment complexity: Surgical options may be necessary, requiring coordination with ophthalmology.
  • Documentation requirements: Must include detailed descriptions of symptoms, history, and examination findings.
  • Coding specificity: Requires precise coding to differentiate from other types of entropion.

Audit Risk Factors

  • Common coding errors: Misidentification of the eyelid affected or confusion with other eyelid disorders.
  • Documentation gaps: Incomplete patient history or lack of detailed examination notes.
  • Billing challenges: Potential for 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 impact a patient's quality of life, leading to discomfort and potential vision loss if untreated. Understanding its prevalence and management is crucial for improving population health outcomes. Effective treatment can reduce healthcare utilization by preventing complications such as corneal damage, thereby enhancing overall patient care and satisfaction.

ICD-9 vs ICD-10

Cicatricial entropion can significantly impact a patient's quality of life, leading to discomfort and potential vision loss if untreated. Understanding its prevalence and management is crucial for improving population health outcomes. Effective treatment can reduce healthcare utilization by preventing complications such as corneal damage, thereby enhancing overall patient care and satisfaction.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the procedure codes used align with the diagnosis. Common denials may arise from insufficient documentation or lack of clarity regarding the condition's impact on the patient's vision. Best practices include maintaining thorough records of patient evaluations, treatment plans, and follow-up care to substantiate claims.

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 H02.014?

H02.014 specifically covers cicatricial entropion of the left upper eyelid, which is caused by scarring. This may include conditions resulting from trauma, surgery, or chronic inflammatory diseases that lead to eyelid malposition.

When should H02.014 be used instead of related codes?

H02.014 should be used when the diagnosis specifically indicates cicatricial entropion of the left upper eyelid. It is important to differentiate it from other types of entropion, such as involutional or spastic entropion, which have different underlying causes.

What documentation supports H02.014?

Documentation should include a detailed history of the patient's eyelid condition, any previous surgeries or trauma, a comprehensive eye examination, and specific findings related to the cicatricial entropion of the left upper eyelid.