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ICD-10 Guide
ICD-10 CodesH02.119

H02.119

Billable

Cicatricial ectropion of unspecified eye, unspecified eyelid

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

Code Description

ICD-10 H02.119 is a billable code used to indicate a diagnosis of cicatricial ectropion of unspecified eye, unspecified eyelid.

Key Diagnostic Point:

Cicatricial ectropion of the unspecified eye and unspecified eyelid is characterized by the outward turning of the eyelid margin due to scarring. This condition can arise from various etiologies, including trauma, surgical interventions, or inflammatory processes that lead to fibrosis of the eyelid tissues. The eyelid anatomy involved includes the skin, muscle (orbicularis oculi), and conjunctiva, which may be affected by the ectropion. Clinically, patients may present with symptoms such as ocular irritation, excessive tearing, exposure keratitis, and cosmetic concerns. Disease progression can lead to chronic discomfort and potential vision impairment if left untreated. Diagnostic considerations include a thorough history and physical examination, with attention to the eyelid's position and function, as well as any underlying conditions that may contribute to scarring. Additional diagnostic tools may include slit-lamp examination and, in some cases, imaging studies to assess the orbit and surrounding structures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive assessment of eyelid anatomy and function.
  • Treatment complexity: May involve surgical intervention or conservative management depending on severity.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected eyelid or misclassification of the condition.
  • Documentation gaps: Insufficient clinical details to support the diagnosis may lead to claim denials.
  • Billing challenges: Variability in payer requirements for documentation and coding specificity can complicate reimbursement.

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

Dermatology

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 vision impairment. Understanding the epidemiology of this condition is crucial, as it may arise from various underlying health issues, including skin diseases and previous surgeries. Effective management and coding of this condition can improve healthcare utilization patterns and ensure that patients receive appropriate care and interventions.

ICD-9 vs ICD-10

Cicatricial ectropion can significantly affect a patient's quality of life, leading to discomfort, cosmetic concerns, and potential vision impairment. Understanding the epidemiology of this condition is crucial, as it may arise from various underlying health issues, including skin diseases and previous surgeries. Effective management and coding of this condition can improve healthcare utilization patterns and ensure that patients receive appropriate care and interventions.

Reimbursement & Billing Impact

impact on the patient's quality of life. Reimbursement considerations include the necessity of surgical intervention, which may be covered under CPT codes 67904 or 67906. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Coders should ensure that all relevant clinical details are included in the patient's medical record to support the diagnosis and treatment plan, adhering to payer-specific guidelines for optimal reimbursement.

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 H02.119?

H02.119 covers cicatricial ectropion resulting from scarring of the eyelid, which can be due to various causes such as trauma, surgery, or inflammatory diseases. It is important to differentiate this from other forms of ectropion that may not involve scarring.

When should H02.119 be used instead of related codes?

H02.119 should be used when the specific eyelid affected is not documented, or when the cicatricial nature of the ectropion is confirmed without specifying the eye or eyelid. If the condition is localized to a specific eyelid, related codes should be used.

What documentation supports H02.119?

Documentation should include a detailed clinical examination noting the eyelid's position, any signs of scarring, patient symptoms, and any relevant history of trauma or surgery. Photographic evidence may also support the diagnosis.