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ICD-10 Guide
ICD-10 CodesH02.214

H02.214

Billable

Cicatricial lagophthalmos left upper eyelid

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

Code Description

ICD-10 H02.214 is a billable code used to indicate a diagnosis of cicatricial lagophthalmos left upper eyelid.

Key Diagnostic Point:

Cicatricial lagophthalmos of the left upper eyelid is a condition characterized by incomplete closure of the eyelid due to scarring or fibrosis. This condition can result from various causes, including trauma, surgical intervention, or inflammatory diseases that lead to eyelid deformities. The eyelid anatomy is crucial in understanding this disorder; it consists of skin, muscle, and connective tissue that work together to protect the eye and maintain moisture. In cicatricial lagophthalmos, the scarring may affect the orbicularis oculi muscle, impairing its function and leading to exposure keratitis, dry eye syndrome, and potential corneal damage. Disease progression can vary, with some patients experiencing mild symptoms while others may develop significant ocular complications. Diagnostic considerations include a thorough clinical examination, patient history, and possibly imaging studies to assess the extent of scarring and its impact on eyelid function. Treatment options may involve surgical correction, lubricating eye drops, or other interventions aimed at restoring eyelid function and protecting the ocular surface.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive understanding of eyelid anatomy and potential underlying causes.
  • Treatment complexity: May involve surgical and non-surgical interventions, necessitating multidisciplinary approaches.
  • Documentation requirements: Detailed clinical notes are essential to justify the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other forms of lagophthalmos.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected eyelid or confusion with other eyelid disorders.
  • Documentation gaps: Incomplete patient history or lack of detailed examination notes.
  • Billing challenges: Potential denials due to insufficient justification 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 impact a patient's quality of life by affecting vision and ocular health. It may lead to increased healthcare utilization due to complications such as corneal ulcers or infections. Understanding the epidemiology of this condition is essential for developing preventive strategies and improving patient outcomes, particularly in populations at higher risk for eyelid scarring.

ICD-9 vs ICD-10

Cicatricial lagophthalmos can significantly impact a patient's quality of life by affecting vision and ocular health. It may lead to increased healthcare utilization due to complications such as corneal ulcers or infections. Understanding the epidemiology of this condition is essential for developing preventive strategies and improving patient outcomes, particularly in populations at higher risk for eyelid scarring.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the treatment provided, whether surgical or non-surgical. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Coders should ensure that all relevant clinical information is included in the claim to support the diagnosis and treatment plan, adhering to payer-specific guidelines.

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 H02.214?

H02.214 specifically covers cicatricial lagophthalmos of the left upper eyelid, which can arise from trauma, surgical scarring, or inflammatory conditions affecting the eyelid's structural integrity.

When should H02.214 be used instead of related codes?

H02.214 should be used when the condition specifically involves cicatricial lagophthalmos of the left upper eyelid, as opposed to right-sided involvement or other forms of eyelid dysfunction.

What documentation supports H02.214?

Documentation should include a detailed clinical examination, patient history indicating the cause of cicatricial changes, and any imaging studies that support the diagnosis of lagophthalmos.