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ICD-10 Guide
ICD-10 CodesH02.146

H02.146

Billable

Spastic ectropion of left eye, unspecified eyelid

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

Code Description

ICD-10 H02.146 is a billable code used to indicate a diagnosis of spastic ectropion of left eye, unspecified eyelid.

Key Diagnostic Point:

Spastic ectropion of the left eye, unspecified eyelid, is characterized by an outward turning of the eyelid margin due to involuntary muscle contractions. This condition can lead to exposure of the conjunctiva and cornea, resulting in irritation, dryness, and potential damage to the ocular surface. The eyelids play a crucial role in protecting the eye and maintaining tear film stability. The anatomy involved includes the orbicularis oculi muscle, which controls eyelid movement, and the surrounding periocular structures. Disease progression may vary; if left untreated, spastic ectropion can lead to chronic discomfort, increased risk of infection, and visual impairment. Diagnosis typically involves a comprehensive eye examination, including assessment of eyelid position, tear production, and ocular surface health. Diagnostic considerations may include ruling out other eyelid disorders such as mechanical ectropion or involutional ectropion, which have different underlying causes and treatment approaches.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough examination and differentiation from other eyelid conditions.
  • Treatment complexity: May involve conservative management or surgical intervention depending on severity.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to capture the specific nature of the ectropion.

Audit Risk Factors

  • Common coding errors: Misidentifying the type of ectropion or the eyelid involved.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis.
  • Billing challenges: Potential denials due to lack of clear evidence of medical necessity.

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

Oculoplastic 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

Spastic ectropion can significantly impact a patient's quality of life, leading to discomfort and potential visual impairment. Understanding the epidemiology of eyelid disorders is crucial, as they can affect a broad population, particularly among the elderly. Effective management of ectropion not only improves individual patient outcomes but also reduces healthcare utilization by preventing complications such as infections or corneal damage.

ICD-9 vs ICD-10

Spastic ectropion can significantly impact a patient's quality of life, leading to discomfort and potential visual impairment. Understanding the epidemiology of eyelid disorders is crucial, as they can affect a broad population, particularly among the elderly. Effective management of ectropion not only improves individual patient outcomes but also reduces healthcare utilization by preventing complications such as infections or corneal damage.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, but typically, surgical interventions for ectropion repair are covered when medically necessary. Common denials may arise from insufficient documentation or lack of evidence for the need for surgical correction. Best practices include ensuring that all clinical findings are clearly documented and that the medical necessity for the procedure is well established.

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 H02.146?

H02.146 specifically covers spastic ectropion of the left eyelid, which is characterized by involuntary muscle contractions leading to eyelid eversion. It does not cover other forms of ectropion such as mechanical or involutional ectropion.

When should H02.146 be used instead of related codes?

H02.146 should be used when the patient presents with spastic ectropion specifically affecting the left eyelid. It is important to differentiate it from other types of ectropion based on clinical findings.

What documentation supports H02.146?

Documentation should include a detailed eye examination report, noting the eyelid position, any associated symptoms (e.g., irritation, tearing), and the clinical rationale for the diagnosis of spastic ectropion.