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ICD-10 Guide
ICD-10 CodesH02.111

H02.111

Billable

Cicatricial ectropion of right upper eyelid

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

Code Description

ICD-10 H02.111 is a billable code used to indicate a diagnosis of cicatricial ectropion of right upper eyelid.

Key Diagnostic Point:

Cicatricial ectropion of the right upper eyelid is a condition characterized by the outward turning of the eyelid margin due to scarring. This condition often results from trauma, surgical interventions, or chronic inflammatory processes that lead to fibrosis and retraction of the eyelid tissues. The right upper eyelid's anatomy includes the skin, orbicularis oculi muscle, tarsal plate, and conjunctiva, all of which can be affected by cicatricial changes. Clinically, patients may present with symptoms such as ocular irritation, excessive tearing, exposure keratitis, and cosmetic concerns. The disease progression can lead to further complications, including corneal exposure and potential vision impairment if left untreated. Diagnostic considerations involve a thorough history, physical examination, and possibly imaging studies to assess the extent of the ectropion and any underlying causes. Treatment typically involves surgical correction to restore the eyelid's normal position and function, which may include procedures such as eyelid tightening or skin grafting.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive evaluation of eyelid anatomy and function.
  • Treatment complexity: Surgical intervention may be necessary, requiring specialized skills.
  • Documentation requirements: Detailed clinical notes are essential to support the diagnosis.
  • Coding specificity: Accurate coding is crucial to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the eyelid affected (right vs. left).
  • Documentation gaps: Incomplete clinical notes regarding the cause and severity of ectropion.
  • Billing challenges: Potential denials if the surgical procedure 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

Cicatricial ectropion can significantly impact a patient's quality of life, leading to discomfort and potential vision issues. Understanding the epidemiology of eyelid disorders, including cicatricial ectropion, is crucial for healthcare providers to address these conditions effectively. Quality measures may include tracking surgical outcomes and patient satisfaction, while healthcare utilization patterns can reflect the need for timely intervention to prevent complications.

ICD-9 vs ICD-10

Cicatricial ectropion can significantly impact a patient's quality of life, leading to discomfort and potential vision issues. Understanding the epidemiology of eyelid disorders, including cicatricial ectropion, is crucial for healthcare providers to address these conditions effectively. Quality measures may include tracking surgical outcomes and patient satisfaction, while healthcare utilization patterns can reflect the need for timely intervention to prevent complications.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the surgical intervention and the necessity of the procedure as documented in the patient's medical record. Common denials may arise from insufficient documentation or incorrect coding of the affected eyelid. Coders should ensure that all relevant clinical information is included to support the medical necessity of the treatment provided.

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 H02.111?

H02.111 specifically covers cicatricial ectropion of the right upper eyelid, which can result from various causes including trauma, surgery, or chronic inflammatory conditions leading to scarring.

When should H02.111 be used instead of related codes?

H02.111 should be used when the ectropion is specifically due to scarring of the right upper eyelid, distinguishing it from other types of ectropion or from ectropion affecting the left eyelid.

What documentation supports H02.111?

Documentation should include a detailed history of the patient's condition, physical examination findings, the cause of the cicatricial changes, and any previous treatments or surgeries related to the eyelid.