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ICD-10 Guide
ICD-10 CodesH01.122

H01.122

Billable

Discoid lupus erythematosus of right lower eyelid

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

Code Description

ICD-10 H01.122 is a billable code used to indicate a diagnosis of discoid lupus erythematosus of right lower eyelid.

Key Diagnostic Point:

Discoid lupus erythematosus (DLE) of the right lower eyelid is a chronic autoimmune skin condition characterized by well-defined, erythematous plaques with adherent scales, primarily affecting sun-exposed areas, including the eyelids. Clinically, patients may present with symptoms such as localized swelling, itching, and discomfort. The right lower eyelid is particularly susceptible due to its exposure to UV radiation and potential trauma. The disease progression can lead to scarring and pigmentary changes, which may affect the cosmetic appearance and function of the eyelid. Diagnostic considerations include a thorough clinical examination, patient history, and potentially a skin biopsy to confirm the diagnosis and rule out other conditions such as squamous cell carcinoma or basal cell carcinoma. The periocular anatomy, including the eyelid margins, conjunctiva, and surrounding structures, plays a crucial role in the management of DLE, as inflammation can impact tear production and drainage, leading to secondary complications such as dry eye syndrome or conjunctivitis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other eyelid lesions.
  • Treatment complexity: May involve topical corticosteroids, immunomodulators, or systemic therapy.
  • Documentation requirements: Detailed clinical notes and possibly histopathological reports needed.
  • Coding specificity: Requires precise coding to reflect the affected eyelid and condition.

Audit Risk Factors

  • Common coding errors: Misidentification of the condition or affected eyelid.
  • Documentation gaps: Incomplete clinical notes or lack of biopsy results.
  • Billing challenges: Potential denials if documentation does not support the diagnosis.

Specialty Focus

Medical Specialties

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

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

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

Discoid lupus erythematosus can significantly affect patients' quality of life due to its chronic nature and potential for scarring. It is essential to monitor the condition for potential systemic involvement, as lupus can have broader implications for population health. Quality measures may include tracking treatment outcomes and patient satisfaction, while healthcare utilization patterns may reflect increased visits for management of this chronic condition.

ICD-9 vs ICD-10

Discoid lupus erythematosus can significantly affect patients' quality of life due to its chronic nature and potential for scarring. It is essential to monitor the condition for potential systemic involvement, as lupus can have broader implications for population health. Quality measures may include tracking treatment outcomes and patient satisfaction, while healthcare utilization patterns may reflect increased visits for management of this chronic condition.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the condition and the necessity for follow-up visits. Common denials may arise from insufficient documentation or failure to provide evidence of the condition's impact on the patient's quality of life. Best practices include ensuring that all clinical notes are thorough and that any procedures performed are clearly linked to the diagnosis.

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 H01.122?

H01.122 specifically covers discoid lupus erythematosus affecting the right lower eyelid. It is characterized by chronic, scaly lesions that can cause cosmetic and functional issues.

When should H01.122 be used instead of related codes?

H01.122 should be used when the diagnosis is confirmed as discoid lupus erythematosus localized to the right lower eyelid, differentiating it from other eyelid disorders such as dermatitis or basal cell carcinoma.

What documentation supports H01.122?

Documentation should include a detailed clinical examination, patient history, and, if applicable, results from a skin biopsy confirming discoid lupus erythematosus.