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ICD-10 Guide
ICD-10 CodesH02.004

H02.004

Billable

Unspecified entropion of left upper eyelid

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

Code Description

ICD-10 H02.004 is a billable code used to indicate a diagnosis of unspecified entropion of left upper eyelid.

Key Diagnostic Point:

Unspecified entropion of the left upper eyelid is a condition characterized by the inward turning of the eyelid margin, which can lead to irritation of the conjunctiva and cornea due to direct contact with the eyelashes. The left upper eyelid is anatomically significant as it plays a crucial role in protecting the eye and maintaining tear film stability. The condition may present with symptoms such as redness, tearing, and discomfort, and can be associated with age-related changes, scarring, or congenital factors. Disease progression may lead to chronic irritation, corneal abrasion, or even vision impairment if left untreated. Diagnosis typically involves a thorough ocular examination, including assessment of eyelid position, eyelash orientation, and evaluation of the ocular surface. Additional diagnostic considerations may include imaging studies if underlying orbital or lacrimal system involvement is suspected. Treatment options range from conservative management, such as lubricating eye drops, to surgical intervention to correct the eyelid position, depending on the severity and underlying cause of the entropion.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive ocular examination and potential imaging.
  • Treatment complexity: May involve both conservative and surgical approaches.
  • Documentation requirements: Detailed clinical notes and rationale for treatment are essential.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of eyelid location or type of entropion.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and treatment rationale.
  • Billing challenges: Potential denials if documentation does not support the diagnosis or treatment.

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

Unspecified entropion of the left upper eyelid can significantly affect a patient's quality of life due to discomfort and potential vision impairment. Understanding the epidemiology of eyelid disorders is essential for healthcare providers, as these conditions can lead to increased healthcare utilization, including surgical interventions. Quality measures related to patient outcomes and satisfaction are critical in managing such conditions, emphasizing the importance of timely diagnosis and appropriate treatment.

ICD-9 vs ICD-10

Unspecified entropion of the left upper eyelid can significantly affect a patient's quality of life due to discomfort and potential vision impairment. Understanding the epidemiology of eyelid disorders is essential for healthcare providers, as these conditions can lead to increased healthcare utilization, including surgical interventions. Quality measures related to patient outcomes and satisfaction are critical in managing such conditions, emphasizing the importance of timely diagnosis and appropriate treatment.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the medical necessity of the treatment provided, whether conservative or surgical. Common denials may arise from insufficient documentation or lack of clarity regarding the diagnosis. Best practices include maintaining thorough clinical notes, ensuring that the procedure codes align with the diagnosis, and providing clear justifications for the treatment approach taken.

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 H02.004?

H02.004 covers unspecified entropion of the left upper eyelid, which may include cases due to aging, scarring, or congenital factors. It does not specify the underlying cause, allowing for broader application in clinical settings.

When should H02.004 be used instead of related codes?

H02.004 should be used when the entropion of the left upper eyelid is diagnosed but the specific etiology is not identified. If the cause is known, more specific codes should be utilized.

What documentation supports H02.004?

Documentation should include a detailed ocular examination, patient history, symptoms reported, and any treatments attempted. Clear notes on the diagnosis and rationale for the chosen treatment plan are essential.