ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesH02.226

H02.226

Billable

Mechanical lagophthalmos left eye, unspecified eyelid

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

Code Description

ICD-10 H02.226 is a billable code used to indicate a diagnosis of mechanical lagophthalmos left eye, unspecified eyelid.

Key Diagnostic Point:

Mechanical lagophthalmos of the left eye, specifically involving the unspecified eyelid, is characterized by the inability to fully close the eyelid due to mechanical obstruction or dysfunction. This condition can arise from various etiologies, including scarring, eyelid malposition, or structural abnormalities. The eyelids play a crucial role in protecting the ocular surface, maintaining moisture, and facilitating tear distribution. In cases of lagophthalmos, patients may experience symptoms such as dryness, irritation, and exposure keratitis, which can lead to further complications if left untreated. The condition may progress to more severe ocular surface damage if the underlying cause is not addressed. Diagnosis typically involves a thorough clinical examination, including assessment of eyelid function, tear film stability, and ocular surface health. Diagnostic imaging may be utilized to evaluate the anatomical structures of the eyelid and surrounding tissues. Treatment options vary based on the underlying cause and may include surgical intervention, lubricating eye drops, or other supportive measures to enhance eyelid closure and protect the cornea.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive evaluation of eyelid function and ocular health.
  • Treatment complexity: May involve surgical and non-surgical interventions depending on the cause.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentifying the affected eye or failing to document the underlying cause.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis or treatment plan.
  • Billing challenges: Potential denials if the medical necessity is not clearly established.

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

Mechanical lagophthalmos can significantly impact a patient's quality of life by causing discomfort, visual disturbances, and potential complications such as corneal ulcers. Understanding the epidemiology of this condition is vital, as it can affect diverse populations, particularly those with a history of eyelid trauma or surgery. Addressing lagophthalmos through appropriate interventions can improve ocular health outcomes and reduce healthcare utilization related to complications.

ICD-9 vs ICD-10

Mechanical lagophthalmos can significantly impact a patient's quality of life by causing discomfort, visual disturbances, and potential complications such as corneal ulcers. Understanding the epidemiology of this condition is vital, as it can affect diverse populations, particularly those with a history of eyelid trauma or surgery. Addressing lagophthalmos through appropriate interventions can improve ocular health outcomes and reduce healthcare utilization related to complications.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, so it is crucial to verify coverage policies. Common denials may arise from insufficient documentation or lack of medical necessity, emphasizing the need for clear and thorough records. Coding best practices recommend using modifiers when applicable to indicate the specific nature of the treatment provided.

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 H02.226?

H02.226 specifically covers mechanical lagophthalmos of the left eye, which can result from conditions such as eyelid trauma, scarring, or congenital malformations that prevent complete eyelid closure.

When should H02.226 be used instead of related codes?

H02.226 should be used when the condition specifically affects the left eyelid and is due to mechanical causes. It is important to differentiate it from other forms of lagophthalmos that may be neurological or functional in nature.

What documentation supports H02.226?

Documentation should include a detailed history of the patient's symptoms, clinical findings from the eye examination, any imaging studies performed, and a treatment plan that outlines the rationale for the selected interventions.