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ICD-10 Guide
ICD-10 CodesH02.021

H02.021

Billable

Mechanical entropion of right upper eyelid

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

Code Description

ICD-10 H02.021 is a billable code used to indicate a diagnosis of mechanical entropion of right upper eyelid.

Key Diagnostic Point:

Mechanical entropion of the right upper eyelid is characterized by the inward turning of the eyelid margin, leading to irritation of the conjunctiva and cornea. This condition can arise from various factors, including age-related changes, scarring from previous injuries, or chronic inflammation. The anatomy involved includes the eyelid structures such as the orbicularis oculi muscle, tarsal plate, and the conjunctival surface. Disease progression may lead to symptoms such as redness, tearing, and discomfort, potentially resulting in corneal abrasions or ulcers if left untreated. Diagnostic considerations include a thorough ocular examination, patient history, and possibly imaging studies to assess underlying causes. Treatment often involves surgical intervention to correct the eyelid position, and understanding the periocular anatomy is crucial for successful outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a detailed ocular examination and understanding of eyelid anatomy.
  • Treatment complexity: Surgical options may vary based on the underlying cause and severity.
  • Documentation requirements: Must include detailed clinical findings and rationale for treatment.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the eyelid involved or confusion with other eyelid disorders.
  • Documentation gaps: Incomplete clinical notes regarding the patient's history and examination findings.
  • Billing challenges: Potential denials if the medical necessity for surgery is not well-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

Mechanical entropion can significantly affect a patient's quality of life due to discomfort and potential vision impairment. Understanding the epidemiology of eyelid disorders helps healthcare providers identify at-risk populations, particularly the elderly. Quality measures related to timely intervention can improve patient outcomes and reduce healthcare utilization associated with complications from untreated eyelid conditions.

ICD-9 vs ICD-10

Mechanical entropion can significantly affect a patient's quality of life due to discomfort and potential vision impairment. Understanding the epidemiology of eyelid disorders helps healthcare providers identify at-risk populations, particularly the elderly. Quality measures related to timely intervention can improve patient outcomes and reduce healthcare utilization associated with complications from untreated eyelid conditions.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the medical necessity of the procedure, ensuring that the documentation supports the diagnosis, and being aware of common denial reasons such as lack of pre-authorization or insufficient clinical evidence. Best practices include thorough documentation of patient history, examination findings, and treatment plans to avoid billing challenges.

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 H02.021?

H02.021 specifically covers mechanical entropion of the right upper eyelid, which may be caused by factors such as age-related changes, scarring, or other mechanical influences that lead to eyelid inversion.

When should H02.021 be used instead of related codes?

H02.021 should be used when the condition specifically involves the right upper eyelid and is due to mechanical causes, differentiating it from other forms of entropion or eyelid disorders.

What documentation supports H02.021?

Documentation should include a comprehensive ocular examination, patient history detailing the onset and duration of symptoms, and any previous treatments or interventions related to the eyelid condition.