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ICD-10 Guide
ICD-10 CodesH02.201

H02.201

Billable

Unspecified lagophthalmos right upper eyelid

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

Code Description

ICD-10 H02.201 is a billable code used to indicate a diagnosis of unspecified lagophthalmos right upper eyelid.

Key Diagnostic Point:

Lagophthalmos is a condition characterized by the inability to completely close the eyelids, which can lead to exposure of the cornea and subsequent ocular complications. In the case of unspecified lagophthalmos of the right upper eyelid, the patient may experience symptoms such as dryness, irritation, and potential damage to the corneal surface due to prolonged exposure. The anatomy involved includes the eyelids, which consist of skin, muscle, and connective tissue, as well as the lacrimal system responsible for tear production and drainage. The orbicularis oculi muscle plays a crucial role in eyelid closure, and any dysfunction or paralysis can result in lagophthalmos. This condition can progress if left untreated, leading to keratitis or even corneal ulceration. Diagnostic considerations include a thorough clinical examination, assessment of eyelid function, and possibly imaging studies to evaluate underlying causes such as facial nerve palsy or structural abnormalities. Treatment may involve protective measures, lubricating eye drops, or surgical interventions to restore eyelid closure.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful assessment of eyelid function and potential underlying causes.
  • Treatment complexity: May involve both conservative and surgical management options.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis.
  • Coding specificity: Requires accurate coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misclassification of lagophthalmos with other eyelid conditions.
  • Documentation gaps: Incomplete clinical notes may lead to denials.
  • Billing challenges: Potential for reimbursement issues if the condition is not well-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

Lagophthalmos can significantly affect a patient's quality of life, leading to discomfort and potential vision loss if not addressed. The condition is relevant in population health as it may be associated with neurological disorders or trauma, impacting healthcare utilization patterns. Effective management of lagophthalmos can improve patient outcomes and reduce the incidence of complications, contributing to overall public health initiatives aimed at enhancing eye care.

ICD-9 vs ICD-10

Lagophthalmos can significantly affect a patient's quality of life, leading to discomfort and potential vision loss if not addressed. The condition is relevant in population health as it may be associated with neurological disorders or trauma, impacting healthcare utilization patterns. Effective management of lagophthalmos can improve patient outcomes and reduce the incidence of complications, contributing to overall public health initiatives aimed at enhancing eye care.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear clinical evidence of lagophthalmos and its impact on the patient's quality of life. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures related to eyelid repair. Coders should ensure that all relevant clinical notes, treatment plans, and patient histories are included to support claims and minimize the risk of audits.

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 H02.201?

H02.201 covers unspecified lagophthalmos of the right upper eyelid, which may arise from various causes including facial nerve paralysis, trauma, or congenital conditions. It does not specify the underlying etiology, allowing for broader application in clinical settings.

When should H02.201 be used instead of related codes?

H02.201 should be used when the specific cause of lagophthalmos is not documented or when the clinician has not specified a more detailed diagnosis. If the lagophthalmos is due to a known condition, a more specific code should be selected.

What documentation supports H02.201?

Documentation should include a detailed history of the patient's symptoms, a physical examination of eyelid function, and any relevant imaging studies or assessments that support the diagnosis of lagophthalmos.