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ICD-10 Guide
ICD-10 CodesH01.013

H01.013

Billable

Ulcerative blepharitis right eye, unspecified eyelid

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

Code Description

ICD-10 H01.013 is a billable code used to indicate a diagnosis of ulcerative blepharitis right eye, unspecified eyelid.

Key Diagnostic Point:

Ulcerative blepharitis is an inflammatory condition affecting the eyelids, characterized by the presence of crusted, ulcerated lesions primarily on the margins of the eyelids. The right eye is specified, indicating unilateral involvement, and the term 'unspecified eyelid' suggests that the specific eyelid (upper or lower) is not detailed in the diagnosis. The condition often presents with symptoms such as redness, swelling, itching, and discomfort, which can lead to secondary infections if not treated. The anatomy involved includes the eyelid structures, such as the skin, meibomian glands, and hair follicles, which can become obstructed or infected. Disease progression may lead to chronic inflammation, scarring, and potential complications like trichiasis or ectropion if left untreated. Diagnostic considerations include a thorough clinical examination, patient history, and possibly microbiological cultures to identify any underlying infections. Treatment typically involves proper eyelid hygiene, topical antibiotics, and anti-inflammatory medications, with the goal of alleviating symptoms and preventing recurrence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and differentiation from other eyelid disorders.
  • Treatment complexity: Involves multiple treatment modalities and patient compliance.
  • Documentation requirements: Detailed documentation of symptoms, treatment response, and follow-up is necessary.
  • Coding specificity: Requires accurate coding to specify the affected eye and eyelid.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected eyelid or eye.
  • Documentation gaps: Incomplete patient history or treatment details.
  • 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

Dermatology

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

Ulcerative blepharitis can significantly impact patient quality of life due to discomfort and potential vision impairment. It is essential for population health as it can lead to increased healthcare utilization, including visits to ophthalmologists and dermatologists. Understanding the epidemiology of this condition helps in developing quality measures and preventive strategies to reduce its incidence and improve patient outcomes.

ICD-9 vs ICD-10

Ulcerative blepharitis can significantly impact patient quality of life due to discomfort and potential vision impairment. It is essential for population health as it can lead to increased healthcare utilization, including visits to ophthalmologists and dermatologists. Understanding the epidemiology of this condition helps in developing quality measures and preventive strategies to reduce its incidence and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the services provided, such as eyelid hygiene education or prescription medications. Common denials may arise from insufficient documentation or lack of specificity in the diagnosis. Coders should ensure that all relevant clinical notes, treatment plans, and follow-up visits are documented to support the medical necessity of the billed services.

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 H01.013?

H01.013 covers ulcerative blepharitis affecting the right eye, which may include conditions like seborrheic dermatitis, staphylococcal blepharitis, and other inflammatory eyelid disorders that present with ulceration.

When should H01.013 be used instead of related codes?

H01.013 should be used when the patient presents with ulcerative blepharitis specifically in the right eye, and when the documentation does not specify which eyelid is affected. If the left eye or both eyes are involved, other codes should be selected.

What documentation supports H01.013?

Documentation should include a detailed clinical examination, patient symptoms, treatment history, and any laboratory results that confirm the diagnosis of ulcerative blepharitis in the right eye.