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ICD-10 Guide
ICD-10 CodesH02.116

H02.116

Billable

Cicatricial ectropion of left eye, unspecified eyelid

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

Code Description

ICD-10 H02.116 is a billable code used to indicate a diagnosis of cicatricial ectropion of left eye, unspecified eyelid.

Key Diagnostic Point:

Cicatricial ectropion of the left eye, unspecified eyelid, is a condition characterized by the outward turning of the eyelid due to scarring. This condition can result from various causes, including trauma, surgical interventions, or inflammatory diseases that lead to fibrosis and subsequent retraction of the eyelid. The anatomy involved includes the eyelid structures, such as the skin, orbicularis oculi muscle, and the conjunctiva. The lacrimal system may also be affected, leading to inadequate tear drainage and potential dry eye symptoms. Disease progression can vary; initially, patients may experience mild discomfort or cosmetic concerns, but as the ectropion worsens, it can lead to exposure keratitis, conjunctival irritation, and increased risk of infection. Diagnostic considerations include a thorough clinical examination, patient history, and possibly imaging studies to assess the extent of the scarring and any associated conditions. Treatment options may range from conservative management, such as lubricating eye drops, to surgical correction, depending on the severity of the ectropion and its impact on the patient's quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive evaluation of eyelid anatomy and function.
  • Treatment complexity: May involve both medical and surgical interventions.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected eyelid or confusion with other ectropion types.
  • Documentation gaps: Incomplete clinical notes that do not adequately describe the condition.
  • Billing challenges: Potential denials if the medical necessity for treatment 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

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, cosmetic concerns, and potential complications such as exposure keratitis. Understanding the epidemiology of this condition is crucial, as it can arise from various underlying causes, including trauma and surgical complications. Addressing this condition effectively can improve patient outcomes, reduce healthcare utilization, and enhance overall population health.

ICD-9 vs ICD-10

Cicatricial ectropion can significantly affect a patient's quality of life, leading to discomfort, cosmetic concerns, and potential complications such as exposure keratitis. Understanding the epidemiology of this condition is crucial, as it can arise from various underlying causes, including trauma and surgical complications. Addressing this condition effectively can improve patient outcomes, reduce healthcare utilization, and enhance overall population health.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the surgical procedure, if applicable, and the need for pre-authorization in some cases. Common denials may arise from insufficient documentation or failure to demonstrate the impact of the condition on the patient's daily life. Best practices include maintaining thorough clinical notes, ensuring all relevant details are captured, and using appropriate modifiers when necessary to indicate the specific nature of the procedure performed.

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 H02.116?

H02.116 specifically covers cicatricial ectropion of the left eyelid, which is caused by scarring that leads to the eyelid turning outward. This can occur due to various factors such as trauma, surgery, or inflammatory conditions.

When should H02.116 be used instead of related codes?

H02.116 should be used when the ectropion is specifically cicatricial and affects the left eyelid. It is important to differentiate it from other types of ectropion, such as involutional or paralytic ectropion, which have different underlying causes.

What documentation supports H02.116?

Documentation should include a detailed clinical examination, patient history indicating the cause of the cicatricial ectropion, and any relevant imaging studies. Notes should clearly describe the extent of the condition and its impact on the patient's vision and quality of life.