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ICD-10 Guide
ICD-10 CodesH02.016

H02.016

Billable

Cicatricial entropion of left eye, unspecified eyelid

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

Code Description

ICD-10 H02.016 is a billable code used to indicate a diagnosis of cicatricial entropion of left eye, unspecified eyelid.

Key Diagnostic Point:

Cicatricial entropion of the left eye, unspecified eyelid, is a condition characterized by the inward turning of the eyelid 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 that may be affected by previous trauma, surgery, or inflammatory diseases. Disease progression can lead to chronic irritation and potential vision impairment if left untreated. Diagnostic considerations include a thorough ocular examination, patient history, and assessment of any underlying conditions that may contribute to scarring. Treatment options may vary from conservative management, such as lubricating eye drops, to surgical intervention to correct the eyelid position. Proper diagnosis and management are crucial to prevent complications associated with chronic entropion, including corneal ulcers and infections.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough examination and history-taking to differentiate from other eyelid disorders.
  • Treatment complexity: May involve both medical and surgical management depending on severity.
  • Documentation requirements: Detailed documentation of symptoms, examination findings, and treatment plans is essential.
  • Coding specificity: Requires precise coding to indicate the specific eyelid affected and the nature of the condition.

Audit Risk Factors

  • Common coding errors: Misidentifying the affected eyelid or failing to document the cicatricial nature.
  • Documentation gaps: Incomplete patient history or lack of detailed examination notes.
  • 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

Cicatricial entropion can significantly affect a patient's quality of life, leading to discomfort and potential vision loss. Understanding the epidemiology of this condition is essential, 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 such as corneal damage.

ICD-9 vs ICD-10

Cicatricial entropion can significantly affect a patient's quality of life, leading to discomfort and potential vision loss. Understanding the epidemiology of this condition is essential, 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 such as corneal damage.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure performed, whether it is surgical or non-surgical. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Coders should ensure that all relevant details are captured, including the specific eyelid affected and the nature of the cicatricial changes. Best practices include maintaining thorough records of patient interactions and treatment outcomes to support 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 H02.016?

H02.016 specifically covers cicatricial entropion of the left eye, which may arise from conditions such as trauma, surgery, or inflammatory diseases that cause scarring of the eyelid.

When should H02.016 be used instead of related codes?

H02.016 should be used when the diagnosis specifically indicates cicatricial entropion of the left eyelid, differentiating it from other forms of entropion or conditions affecting the right eyelid.

What documentation supports H02.016?

Documentation should include a comprehensive ocular examination, patient history detailing any prior eyelid trauma or surgery, and a clear description of the entropion's characteristics and symptoms.