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ICD-10 Guide
ICD-10 CodesH02.113

H02.113

Billable

Cicatricial ectropion of right eye, unspecified eyelid

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

Code Description

ICD-10 H02.113 is a billable code used to indicate a diagnosis of cicatricial ectropion of right eye, unspecified eyelid.

Key Diagnostic Point:

Cicatricial ectropion of the right eye, unspecified eyelid, is characterized by the outward turning of the eyelid margin due to scarring. This condition can result from various factors, including trauma, surgery, or inflammatory diseases that lead to fibrosis of the eyelid tissue. The anatomy involved includes the eyelid structures such as the skin, orbicularis oculi muscle, and conjunctiva, which may be affected by the retraction caused by cicatricial changes. Patients typically present with symptoms such as ocular irritation, exposure keratitis, and tearing due to impaired eyelid function. Disease progression can lead to chronic discomfort and potential vision impairment if left untreated. Diagnostic considerations include a thorough history and physical examination, often supplemented by imaging studies to assess the extent of eyelid and surrounding tissue involvement. Treatment may involve surgical intervention to correct the eyelid position and restore normal function, alongside addressing the underlying cause of the cicatrix.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful assessment of eyelid anatomy and function.
  • Treatment complexity: May necessitate surgical intervention and follow-up care.
  • Documentation requirements: Detailed clinical notes and imaging may be needed.
  • Coding specificity: Requires precise coding to differentiate from other types of ectropion.

Audit Risk Factors

  • Common coding errors: Misidentifying the eyelid involved or confusing with other ectropion types.
  • Documentation gaps: Incomplete clinical notes regarding the cause and treatment of cicatricial changes.
  • 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

Cicatricial ectropion can significantly affect a patient's quality of life, leading to discomfort and potential vision issues. Understanding the epidemiology of this condition is essential, as it may be more prevalent in populations with higher rates of trauma or surgical interventions. Quality measures related to eyelid disorders focus on timely diagnosis and effective treatment, which can improve healthcare utilization patterns and patient outcomes.

ICD-9 vs ICD-10

Cicatricial ectropion can significantly affect a patient's quality of life, leading to discomfort and potential vision issues. Understanding the epidemiology of this condition is essential, as it may be more prevalent in populations with higher rates of trauma or surgical interventions. Quality measures related to eyelid disorders focus on timely diagnosis and effective treatment, which can improve healthcare utilization patterns and patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the procedure performed is medically necessary and well-documented. Common denials may arise from insufficient documentation or failure to demonstrate the need for surgical intervention. Coders should ensure that all relevant details are captured in the medical record to support the claim and reduce the risk of audits.

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 H02.113?

H02.113 specifically covers cicatricial ectropion of the right eyelid, which may arise from scarring due to trauma, surgery, or inflammatory conditions affecting the eyelid. It is important to document the underlying cause to support the diagnosis.

When should H02.113 be used instead of related codes?

H02.113 should be used when the cicatricial ectropion is specifically on the right eyelid, as opposed to other codes that may pertain to the left eyelid or non-cicatricial forms. Accurate documentation of the condition's specifics is crucial for correct code selection.

What documentation supports H02.113?

Documentation should include a detailed clinical examination, history of eyelid trauma or surgery, and any imaging studies that demonstrate the cicatricial changes. Notes on the patient's symptoms and treatment plan are also essential.