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ICD-10 Guide
ICD-10 CodesH01.123

H01.123

Billable

Discoid lupus erythematosus of right eye, unspecified eyelid

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

Code Description

ICD-10 H01.123 is a billable code used to indicate a diagnosis of discoid lupus erythematosus of right eye, unspecified eyelid.

Key Diagnostic Point:

Discoid lupus erythematosus (DLE) is a chronic autoimmune condition characterized by the formation of disc-shaped lesions primarily affecting the skin, but it can also involve the eyelids, leading to significant cosmetic and functional concerns. In the case of H01.123, the condition specifically affects the right eyelid, which is classified as 'unspecified' due to the lack of detailed specification in the documentation. Clinically, DLE presents as erythematous plaques with adherent scales, which may lead to scarring and pigmentary changes. The eyelid anatomy involved includes the skin, subcutaneous tissue, and potentially the underlying orbicularis oculi muscle. Disease progression can vary, with some patients experiencing intermittent flares triggered by sun exposure or stress. Diagnostic considerations include a thorough clinical examination, patient history, and possibly a biopsy to confirm the diagnosis. It is crucial to differentiate DLE from other eyelid disorders, such as seborrheic dermatitis or squamous cell carcinoma, to ensure appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other skin conditions and potential biopsies.
  • Treatment complexity: May involve topical corticosteroids, immunosuppressants, or photoprotection.
  • Documentation requirements: Detailed clinical notes and possibly histopathological reports are necessary.
  • Coding specificity: Requires precise documentation of the affected eyelid and condition.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected eyelid or misclassification of the condition.
  • Documentation gaps: Incomplete clinical notes or lack of biopsy results.
  • Billing challenges: Potential denials due to insufficient documentation or incorrect coding.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Discoid lupus erythematosus can significantly impact patients' quality of life due to its chronic nature and potential for disfigurement. Understanding its prevalence in the population aids in developing targeted healthcare strategies. Quality measures should focus on early diagnosis and effective management to minimize complications. Epidemiologically, DLE is more common in women and can be associated with systemic lupus erythematosus, highlighting the importance of comprehensive care and monitoring.

ICD-9 vs ICD-10

Discoid lupus erythematosus can significantly impact patients' quality of life due to its chronic nature and potential for disfigurement. Understanding its prevalence in the population aids in developing targeted healthcare strategies. Quality measures should focus on early diagnosis and effective management to minimize complications. Epidemiologically, DLE is more common in women and can be associated with systemic lupus erythematosus, highlighting the importance of comprehensive care and monitoring.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of treatment, which may involve topical therapies or surgical interventions. Common denials may arise from insufficient documentation or incorrect coding, emphasizing the need for accurate clinical notes and supporting evidence. Coders should ensure that the medical necessity for procedures is clearly documented to facilitate successful claims processing.

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 H01.123?

H01.123 specifically covers discoid lupus erythematosus affecting the right eyelid. It is characterized by chronic skin lesions that can cause scarring and pigment changes. It is essential to confirm the diagnosis through clinical evaluation and possibly biopsy.

When should H01.123 be used instead of related codes?

H01.123 should be used when the condition specifically affects the right eyelid and is documented as discoid lupus erythematosus. It is important to differentiate it from other eyelid conditions and specify the affected side.

What documentation supports H01.123?

Documentation should include a detailed clinical examination, patient history, and any relevant laboratory or biopsy results confirming the diagnosis of discoid lupus erythematosus affecting the right eyelid.