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ICD-10 Guide
ICD-10 CodesH02.049

H02.049

Billable

Spastic entropion of unspecified eye, unspecified eyelid

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

Code Description

ICD-10 H02.049 is a billable code used to indicate a diagnosis of spastic entropion of unspecified eye, unspecified eyelid.

Key Diagnostic Point:

Spastic entropion of the unspecified eye and unspecified eyelid is characterized by an involuntary spasm of the eyelid muscles, leading to the inward turning of the eyelid margin. This condition can result in irritation, corneal abrasion, and potential vision impairment due to the eyelashes rubbing against the cornea. The anatomy involved includes the orbicularis oculi muscle, which controls eyelid movement, and the surrounding periocular structures, including the conjunctiva and cornea. Disease progression can vary; if left untreated, spastic entropion can lead to chronic discomfort and complications such as conjunctivitis or corneal ulcers. Diagnostic considerations include a thorough ocular examination, patient history, and possibly imaging studies to rule out underlying conditions such as neurological disorders or previous eyelid surgeries. Treatment options may include botulinum toxin injections to relax the spastic muscles or surgical intervention to correct the eyelid position.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a detailed ocular examination and understanding of eyelid anatomy.
  • Treatment complexity: May involve both non-surgical and surgical options depending on severity.
  • Documentation requirements: Comprehensive documentation of symptoms, examination findings, and treatment plans is essential.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentifying the type of entropion or failing to specify the eyelid involved.
  • Documentation gaps: Incomplete patient history or lack of detailed examination notes.
  • Billing challenges: Potential for denials if documentation does not support the diagnosis or treatment provided.

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

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 its prevalence and impact on population health is crucial for healthcare providers. Effective management of this condition can reduce healthcare utilization by preventing complications such as corneal abrasions and infections. Quality measures may include tracking patient outcomes post-treatment and ensuring timely interventions to improve overall ocular health.

ICD-9 vs ICD-10

Spastic entropion can significantly affect a patient's quality of life, leading to discomfort and potential vision loss. Understanding its prevalence and impact on population health is crucial for healthcare providers. Effective management of this condition can reduce healthcare utilization by preventing complications such as corneal abrasions and infections. Quality measures may include tracking patient outcomes post-treatment and ensuring timely interventions to improve overall ocular health.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of the procedure, which may involve surgical correction or non-surgical interventions like botulinum toxin injections. Common denials may arise from insufficient documentation or lack of medical necessity. Best practices include ensuring that all clinical notes are detailed and that the rationale for treatment is clearly articulated in the patient's medical record, aligning with payer guidelines.

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 H02.049?

H02.049 covers spastic entropion of the eyelid, which may be due to neurological conditions, muscle spasms, or other factors causing involuntary eyelid contraction. It is essential to differentiate it from other forms of entropion, such as involutional or cicatricial entropion.

When should H02.049 be used instead of related codes?

H02.049 should be used when the entropion is spastic and the specific eyelid or eye is not specified. If the condition is localized to a specific eyelid (right or left), then the corresponding specific code should be used.

What documentation supports H02.049?

Documentation should include a comprehensive ocular examination report, patient history detailing symptoms such as irritation or tearing, and any previous treatments attempted. Clear notes on the clinical findings that led to the diagnosis of spastic entropion are also necessary.