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ICD-10 Guide
ICD-10 CodesH02.212

H02.212

Billable

Cicatricial lagophthalmos right lower eyelid

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

Code Description

ICD-10 H02.212 is a billable code used to indicate a diagnosis of cicatricial lagophthalmos right lower eyelid.

Key Diagnostic Point:

Cicatricial lagophthalmos of the right lower eyelid is a condition characterized by incomplete closure of the eyelid due to scarring or fibrosis, often resulting from trauma, surgery, or inflammatory processes. The lower eyelid anatomy includes the skin, muscle (orbicularis oculi), and connective tissue, which are essential for eyelid function and protection of the ocular surface. In cicatricial lagophthalmos, the eyelid fails to close completely, leading to exposure of the cornea and conjunctiva, which can result in dryness, irritation, and potential corneal damage. The condition may progress if left untreated, leading to complications such as keratitis or corneal ulceration. Diagnosis typically involves a thorough clinical examination, including assessment of eyelid movement and corneal health. Additional diagnostic tools may include slit-lamp examination and tear break-up time tests to evaluate ocular surface integrity. Management may involve surgical intervention to restore eyelid function, such as eyelid reconstruction or tarsorrhaphy, alongside supportive care to protect the cornea.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful evaluation of eyelid function and ocular health.
  • Treatment complexity: May involve surgical options and ongoing management.
  • Documentation requirements: Detailed clinical notes are necessary to support diagnosis and treatment.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentifying the affected eyelid or failing to document the cause of lagophthalmos.
  • Documentation gaps: Incomplete records regarding the patient's history and treatment plan.
  • Billing challenges: Potential denials due to lack of supporting documentation for surgical procedures.

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

Cicatricial lagophthalmos can significantly affect a patient's quality of life, leading to discomfort, visual impairment, and increased healthcare utilization due to complications. Understanding the epidemiology of this condition is essential, as it may be more prevalent in populations with higher rates of trauma or surgical interventions. Quality measures should focus on timely diagnosis and effective management to prevent ocular complications and improve patient outcomes.

ICD-9 vs ICD-10

Cicatricial lagophthalmos can significantly affect a patient's quality of life, leading to discomfort, visual impairment, and increased healthcare utilization due to complications. Understanding the epidemiology of this condition is essential, as it may be more prevalent in populations with higher rates of trauma or surgical interventions. Quality measures should focus on timely diagnosis and effective management to prevent ocular complications and improve patient outcomes.

Reimbursement & Billing Impact

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 H02.212?

H02.212 specifically covers cicatricial lagophthalmos of the right lower eyelid, which can result from various causes including trauma, surgical scars, or inflammatory diseases that lead to scarring of the eyelid tissue.

When should H02.212 be used instead of related codes?

H02.212 should be used when the condition specifically involves cicatricial lagophthalmos of the right lower eyelid. It is important to differentiate it from other eyelid disorders, such as H02.211 for the left side or other forms of lagophthalmos that are not cicatricial.

What documentation supports H02.212?

Documentation should include a detailed clinical examination, history of eyelid trauma or surgery, assessment of eyelid closure, and any ocular surface complications. Photographic evidence and treatment plans may also be beneficial.