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ICD-10 Guide
ICD-10 CodesH02.019

H02.019

Billable

Cicatricial entropion of unspecified eye, unspecified eyelid

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

Code Description

ICD-10 H02.019 is a billable code used to indicate a diagnosis of cicatricial entropion of unspecified eye, unspecified eyelid.

Key Diagnostic Point:

Cicatricial entropion of the unspecified eye and unspecified eyelid is a condition characterized by the inward turning of the eyelid margin due to scarring. This condition can lead to irritation, corneal abrasion, and potential vision loss if left untreated. The eyelid anatomy involved includes the tarsal plate, which provides structural support, and the surrounding skin and conjunctiva. The disease progression typically begins with the formation of scar tissue from trauma, surgery, or inflammatory conditions, leading to the eyelid's abnormal positioning. Clinically, patients may present with symptoms such as redness, tearing, and discomfort, often exacerbated by exposure to environmental factors. Diagnostic considerations include a thorough eye examination, patient history, and possibly imaging studies to assess the extent of scarring and any associated ocular surface disease. Treatment options may range from conservative measures, such as lubricating eye drops, to surgical intervention to correct the eyelid position and alleviate symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a detailed assessment of eyelid anatomy and function.
  • Treatment complexity: May involve surgical correction, which requires careful planning and execution.
  • Documentation requirements: Comprehensive documentation of symptoms, examination findings, and treatment plans is essential.
  • Coding specificity: Requires precise coding to differentiate from other types of entropion and eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentifying the type of entropion or failing to specify the eyelid involved.
  • Documentation gaps: Incomplete patient history or examination findings may lead to coding inaccuracies.
  • Billing challenges: Potential denials if documentation does not support the diagnosis or treatment provided.

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

Cicatricial entropion can significantly impact patients' quality of life, leading to discomfort and potential vision impairment. Understanding the epidemiology of this condition is crucial, as it may be more prevalent in populations with a history of ocular trauma or inflammatory diseases. Effective management can reduce healthcare utilization by preventing complications such as corneal ulcers and the need for more extensive surgical interventions.

ICD-9 vs ICD-10

Cicatricial entropion can significantly impact patients' quality of life, leading to discomfort and potential vision impairment. Understanding the epidemiology of this condition is crucial, as it may be more prevalent in populations with a history of ocular trauma or inflammatory diseases. Effective management can reduce healthcare utilization by preventing complications such as corneal ulcers and the need for more extensive surgical interventions.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the procedure performed aligns with the diagnosis coded. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include maintaining thorough records of patient interactions, treatment rationale, and follow-up care to support claims and reduce audit risks.

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 H02.019?

H02.019 covers cicatricial entropion of the unspecified eye and eyelid, which may arise from various causes including trauma, surgery, or inflammatory conditions leading to scarring.

When should H02.019 be used instead of related codes?

H02.019 should be used when the specific eye or eyelid affected is not documented, whereas related codes should be used when the specific eye or eyelid is known.

What documentation supports H02.019?

Documentation should include a detailed patient history, clinical examination findings, and any imaging studies that confirm the diagnosis of cicatricial entropion.