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ICD-10 Guide
ICD-10 CodesH02.04

H02.04

Non-billable

Spastic entropion of eyelid

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

Code Description

ICD-10 H02.04 is a used to indicate a diagnosis of spastic entropion of eyelid.

Key Diagnostic Point:

Spastic entropion of the eyelid is characterized by an involuntary contraction of the eyelid muscles, leading to the inward turning of the eyelid margin. This condition can result in corneal irritation, tearing, and potential damage to the ocular surface due to the eyelashes rubbing against the cornea. The anatomy involved includes the orbicularis oculi muscle, which is responsible for eyelid closure, and the surrounding periocular structures such as the conjunctiva and cornea. Disease progression can vary; if left untreated, spastic entropion may lead to chronic discomfort, recurrent infections, or even vision impairment. Diagnosis typically involves a comprehensive eye examination, including assessment of eyelid position and function, and may require additional imaging or tests to rule out underlying neurological conditions. Clinicians should also consider the patient's history of eyelid trauma, previous surgeries, or neurological disorders that may contribute to the spasticity of the eyelid muscles.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough examination and potential imaging.
  • Treatment complexity: May involve surgical intervention or botulinum toxin injections.
  • Documentation requirements: Detailed clinical notes and history are essential.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentifying spastic entropion as other forms of entropion.
  • Documentation gaps: Incomplete patient history or lack of detailed examination notes.
  • Billing challenges: Potential denials if the medical necessity 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

Neurology

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

Spastic entropion can significantly affect a patient's quality of life, leading to discomfort and potential vision loss. Understanding the epidemiology of this condition is important for healthcare providers, as it may be more prevalent in certain populations, such as the elderly or those with neurological disorders. Effective management and coding of this condition can improve patient outcomes and reduce healthcare utilization by preventing complications associated with untreated entropion.

ICD-9 vs ICD-10

Spastic entropion can significantly affect a patient's quality of life, leading to discomfort and potential vision loss. Understanding the epidemiology of this condition is important for healthcare providers, as it may be more prevalent in certain populations, such as the elderly or those with neurological disorders. Effective management and coding of this condition can improve patient outcomes and reduce healthcare utilization by preventing complications associated with untreated entropion.

Reimbursement & Billing Impact

impact on the patient's vision and quality of life. Common denials may arise from insufficient documentation or failure to demonstrate the need for surgical intervention. It is critical to follow coding best practices, including using the most specific code available and ensuring that all services rendered are supported by the medical record.

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 H02.04?

H02.04 specifically covers spastic entropion, which is caused by involuntary muscle contractions. It may be associated with neurological conditions that affect eyelid function, such as blepharospasm or facial nerve palsy.

When should H02.04 be used instead of related codes?

H02.04 should be used when the entropion is specifically due to spasticity of the eyelid muscles, distinguishing it from other forms of entropion that may be due to structural issues or aging.

What documentation supports H02.04?

Documentation should include a detailed patient history, results from a comprehensive eye examination, and any relevant imaging studies that support the diagnosis of spastic entropion.