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ICD-10 Guide
ICD-10 CodesH02.143

H02.143

Billable

Spastic ectropion of right eye, unspecified eyelid

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

Code Description

ICD-10 H02.143 is a billable code used to indicate a diagnosis of spastic ectropion of right eye, unspecified eyelid.

Key Diagnostic Point:

Spastic ectropion of the right eye, unspecified eyelid, is characterized by the outward turning of the eyelid margin due to involuntary muscle spasms. This condition can lead to exposure of the conjunctiva and cornea, resulting in irritation, dryness, and potential damage to the ocular surface. The eyelid anatomy involved includes the orbicularis oculi muscle, which controls eyelid closure, and the tarsal plate that provides structural support. Disease progression may vary; if left untreated, spastic ectropion can lead to chronic conjunctivitis or corneal ulcers. Diagnostic considerations include a thorough ocular examination, assessment of eyelid function, and possibly imaging studies to evaluate underlying causes such as neurological disorders or trauma. Treatment options may involve addressing the underlying spasticity, surgical correction, or the use of lubricating eye drops to protect the ocular surface.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive evaluation of eyelid function and potential neurological involvement.
  • Treatment complexity: May involve both medical and surgical interventions depending on severity.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of eyelid location or type of ectropion.
  • Documentation gaps: Incomplete clinical notes regarding the nature and duration of symptoms.
  • Billing challenges: Potential denials if the medical necessity is not clearly established.

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

Neurology

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

Spastic ectropion can significantly affect a patient's quality of life, leading to discomfort and potential vision impairment. Understanding the epidemiology of eyelid disorders, including spastic ectropion, is essential for healthcare providers to improve population health outcomes. Effective management can reduce healthcare utilization by preventing complications such as corneal ulcers, which require more intensive treatment. Quality measures should focus on timely diagnosis and intervention to enhance patient care.

ICD-9 vs ICD-10

Spastic ectropion can significantly affect a patient's quality of life, leading to discomfort and potential vision impairment. Understanding the epidemiology of eyelid disorders, including spastic ectropion, is essential for healthcare providers to improve population health outcomes. Effective management can reduce healthcare utilization by preventing complications such as corneal ulcers, which require more intensive treatment. Quality measures should focus on timely diagnosis and intervention to enhance patient care.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for both medical and surgical interventions. Common denials may arise from insufficient documentation or failure to demonstrate the necessity of the procedure. Coders should ensure that all relevant clinical information is included in the claim to support the diagnosis and treatment provided, following best practices for coding and billing in ophthalmology.

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 H02.143?

H02.143 specifically covers spastic ectropion of the right eyelid, which may be caused by neurological disorders, muscle spasms, or trauma. It is essential to differentiate it from other forms of ectropion, such as involutional or cicatricial ectropion.

When should H02.143 be used instead of related codes?

H02.143 should be used when the spastic ectropion is specifically affecting the right eyelid and is due to involuntary muscle contractions. If the condition affects the left eyelid, H02.142 should be used instead.

What documentation supports H02.143?

Documentation should include a detailed history of the patient's symptoms, results from a comprehensive eye examination, and any relevant imaging studies. Notes should clearly indicate the diagnosis of spastic ectropion and the specific eyelid affected.