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ICD-10 Guide
ICD-10 CodesH02.026

H02.026

Billable

Mechanical entropion of left eye, unspecified eyelid

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

Code Description

ICD-10 H02.026 is a billable code used to indicate a diagnosis of mechanical entropion of left eye, unspecified eyelid.

Key Diagnostic Point:

Mechanical entropion of the left eye, unspecified eyelid, is characterized by the inward turning of the eyelid margin, which can lead to irritation of the cornea and conjunctiva due to the eyelashes rubbing against the ocular surface. This condition can arise from various factors, including age-related changes, scarring, or trauma to the eyelid. The anatomy involved includes the eyelids, which serve as protective barriers for the eyes, and the surrounding periocular structures, including the lacrimal system responsible for tear production and drainage. Disease progression may lead to chronic irritation, discomfort, and potential vision impairment if left untreated. Diagnostic considerations include a thorough clinical examination, patient history, and possibly imaging studies to assess the extent of eyelid malposition and any underlying conditions. Treatment options may involve surgical intervention to correct the eyelid position, along with symptomatic management to alleviate discomfort.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires a thorough examination to differentiate from other eyelid disorders.
  • Treatment complexity: Moderate, with surgical options available that necessitate careful planning and execution.
  • Documentation requirements: Requires detailed clinical notes to support diagnosis and treatment.
  • Coding specificity: Specific to mechanical entropion of the left eye, which aids in precise coding.

Audit Risk Factors

  • Common coding errors: Misidentification of the eye involved or confusion with other forms of entropion.
  • Documentation gaps: Incomplete clinical notes that do not clearly outline the diagnosis and treatment plan.
  • Billing challenges: Potential denials if the medical necessity is not well documented.

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

Mechanical entropion can significantly affect a patient's quality of life due to discomfort and potential vision impairment. The condition is more prevalent in older populations, highlighting the need for awareness and timely intervention. Effective management can reduce healthcare utilization by preventing complications such as corneal abrasions or infections, ultimately improving patient outcomes and satisfaction.

ICD-9 vs ICD-10

Mechanical entropion can significantly affect a patient's quality of life due to discomfort and potential vision impairment. The condition is more prevalent in older populations, highlighting the need for awareness and timely intervention. Effective management can reduce healthcare utilization by preventing complications such as corneal abrasions or infections, ultimately improving patient outcomes and satisfaction.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the surgical procedure if performed, as well as any pre-operative evaluations. Common denials may arise from insufficient documentation or failure to demonstrate the need for surgical intervention. Best practices include ensuring that all clinical notes are complete and that the rationale for surgery is clearly articulated in the patient's medical record.

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 H02.026?

H02.026 specifically covers mechanical entropion of the left eye, which may result from various etiologies such as age-related changes, scarring, or trauma. It does not cover other forms of entropion, such as spastic or cicatricial entropion.

When should H02.026 be used instead of related codes?

H02.026 should be used when the condition specifically involves mechanical entropion of the left eyelid. It is important to differentiate it from other types of entropion or conditions affecting the eyelids to ensure accurate coding.

What documentation supports H02.026?

Documentation should include a detailed clinical examination, patient history, and any relevant imaging studies. Notes should clearly describe the mechanical nature of the entropion and its impact on the patient's ocular health.