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ICD-10 Guide
ICD-10 CodesH02.149

H02.149

Billable

Spastic ectropion of unspecified eye, unspecified eyelid

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

Code Description

ICD-10 H02.149 is a billable code used to indicate a diagnosis of spastic ectropion of unspecified eye, unspecified eyelid.

Key Diagnostic Point:

Spastic ectropion of the unspecified eye and eyelid is characterized by an involuntary spasm of the eyelid muscles leading to an outward turning of the eyelid margin. This condition can result in exposure of the conjunctiva and cornea, leading to dryness, irritation, and potential damage to the ocular surface. The eyelid anatomy involved includes the orbicularis oculi muscle, which is responsible for eyelid closure, and the tarsal plate that provides structural support. The lacrimal system may also be affected, as ectropion can disrupt normal tear drainage, exacerbating symptoms of dryness and irritation. Disease progression may vary; if left untreated, chronic exposure can lead to complications such as keratitis or conjunctivitis. Diagnostic considerations include a thorough clinical examination, assessment of eyelid function, and evaluation of tear production. Additional imaging may be warranted in complex cases to rule out underlying orbital or neurological conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires a thorough examination and possibly imaging.
  • Treatment complexity: Moderate, as treatment may involve surgical intervention or conservative management.
  • Documentation requirements: Moderate, necessitating detailed clinical notes and possibly imaging reports.
  • Coding specificity: High, as it specifically identifies spastic ectropion of an unspecified eyelid.

Audit Risk Factors

  • Common coding errors: Misidentification of eyelid type or condition.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and treatment.
  • Billing challenges: Potential denials due to lack of specificity or insufficient documentation.

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

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. The condition may necessitate increased healthcare utilization due to complications such as corneal abrasions or infections. Understanding the epidemiology of eyelid disorders, including spastic ectropion, can aid in developing targeted interventions and improving patient outcomes. Quality measures should focus on timely diagnosis and effective management to reduce the incidence of complications.

ICD-9 vs ICD-10

Spastic ectropion can significantly affect a patient's quality of life, leading to discomfort and potential vision impairment. The condition may necessitate increased healthcare utilization due to complications such as corneal abrasions or infections. Understanding the epidemiology of eyelid disorders, including spastic ectropion, can aid in developing targeted interventions and improving patient outcomes. Quality measures should focus on timely diagnosis and effective management to reduce the incidence of complications.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for surgical interventions, if applicable. Common denials may arise from insufficient documentation or lack of clarity in the diagnosis. Best practices include using precise coding, maintaining thorough records, and ensuring that all relevant clinical information is included in the billing submission.

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 H02.149?

H02.149 covers spastic ectropion of the eyelid, which may arise from neurological conditions, muscle spasms, or other factors leading to eyelid malposition. It is crucial to differentiate it from other forms of ectropion, such as involutional or cicatricial ectropion.

When should H02.149 be used instead of related codes?

H02.149 should be used when the spastic nature of the ectropion is confirmed and the specific eyelid is not identified. If the condition is localized to a specific eyelid, related codes should be considered.

What documentation supports H02.149?

Documentation should include a detailed history of the patient's symptoms, clinical examination findings, and any diagnostic tests performed. Notes should clearly indicate the diagnosis of spastic ectropion and the rationale for the selected code.