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ICD-10 Guide
ICD-10 CodesH02.11

H02.11

Non-billable

Cicatricial ectropion of eyelid

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

Code Description

ICD-10 H02.11 is a used to indicate a diagnosis of cicatricial ectropion of eyelid.

Key Diagnostic Point:

Cicatricial ectropion of the eyelid is a condition characterized by the outward turning of the eyelid margin due to scarring or fibrosis of the eyelid tissue. This condition can lead to exposure of the conjunctiva and cornea, resulting in discomfort, tearing, and potential vision impairment. The eyelid anatomy involved includes the skin, orbicularis oculi muscle, and conjunctival epithelium. Cicatricial ectropion often arises from trauma, surgical interventions, or inflammatory conditions that cause scarring. The disease progression can vary; if left untreated, it may lead to chronic irritation, keratitis, or even corneal ulceration. Diagnosis typically involves a comprehensive eye examination, including assessment of eyelid position and function, and may require imaging studies to evaluate underlying structures. Clinicians should consider the patient's history, including prior surgeries or skin conditions, to establish a clear diagnosis and treatment plan.

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 surgical intervention, which requires careful planning and follow-up.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment.
  • Coding specificity: Requires precise coding to differentiate from other forms of ectropion.

Audit Risk Factors

  • Common coding errors: Misidentification of cicatricial vs. non-cicatricial ectropion.
  • 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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Cicatricial ectropion can significantly affect a patient's quality of life, leading to discomfort and potential vision loss. Understanding the epidemiology of this condition is crucial, as it may arise from various underlying causes, including trauma and surgical complications. Effective management can improve patient outcomes and reduce healthcare utilization by preventing complications such as corneal damage.

ICD-9 vs ICD-10

Cicatricial ectropion can significantly affect a patient's quality of life, leading to discomfort and potential vision loss. Understanding the epidemiology of this condition is crucial, as it may arise from various underlying causes, including trauma and surgical complications. Effective management can improve patient outcomes and reduce healthcare utilization by preventing complications such as corneal damage.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the procedure codes align with the diagnosis and that all necessary pre-operative and post-operative notes are included. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. 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 H02.11?

H02.11 specifically covers cicatricial ectropion resulting from scarring due to trauma, surgery, or inflammatory diseases affecting the eyelid. It is important to differentiate this from other forms of ectropion that may not involve scarring.

When should H02.11 be used instead of related codes?

H02.11 should be used when the ectropion is specifically due to cicatricial changes. If the ectropion is due to other causes such as muscle weakness or neurological conditions, other codes like H02.10 should be considered.

What documentation supports H02.11?

Documentation should include a detailed history of the patient's eyelid condition, results from a comprehensive eye examination, and any relevant imaging studies. Notes should clearly indicate the presence of cicatricial changes and their impact on eyelid function.