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ICD-10 Guide
ICD-10 CodesH02.035

H02.035

Billable

Senile entropion of left lower eyelid

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

Code Description

ICD-10 H02.035 is a billable code used to indicate a diagnosis of senile entropion of left lower eyelid.

Key Diagnostic Point:

Senile entropion of the left lower eyelid is a condition characterized by the inward turning of the eyelid margin, leading to potential irritation of the cornea and conjunctiva due to the eyelashes rubbing against the ocular surface. This condition is often associated with aging, where the structural integrity of the eyelid diminishes, resulting in laxity of the eyelid tissues. The anatomy involved includes the lower eyelid, orbicularis oculi muscle, and the surrounding periocular structures. As the condition progresses, patients may experience symptoms such as redness, tearing, and discomfort, which can significantly impact their quality of life. Diagnostic considerations include a thorough ocular examination, assessment of eyelid position, and evaluation of tear film stability. Treatment options may range from conservative management, such as lubricating eye drops, to surgical intervention, including eyelid tightening procedures, depending on the severity of the entropion and associated symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful assessment of eyelid position and ocular health.
  • Treatment complexity: May involve both non-surgical and surgical options.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misclassification with other eyelid disorders.
  • Documentation gaps: Incomplete clinical notes may lead to denials.
  • Billing challenges: Variability in payer policies regarding surgical interventions.

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

Senile entropion can significantly affect the quality of life for older adults, leading to discomfort and potential complications such as corneal abrasions. Understanding the epidemiology of this condition is crucial, as it is prevalent in the aging population, necessitating appropriate healthcare interventions. Quality measures related to eyelid disorders can help improve patient outcomes and reduce healthcare utilization by addressing these conditions proactively.

ICD-9 vs ICD-10

Senile entropion can significantly affect the quality of life for older adults, leading to discomfort and potential complications such as corneal abrasions. Understanding the epidemiology of this condition is crucial, as it is prevalent in the aging population, necessitating appropriate healthcare interventions. Quality measures related to eyelid disorders can help improve patient outcomes and reduce healthcare utilization by addressing these conditions proactively.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, particularly for surgical interventions, which often require prior authorization. Common denials may arise from insufficient documentation or misclassification of the condition. Best practices include ensuring that all clinical notes are thorough and that the coding accurately reflects the diagnosis and treatment provided.

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 H02.035?

H02.035 specifically covers senile entropion of the left lower eyelid, which is characterized by the inward turning of the eyelid due to age-related changes. It does not include entropion caused by scarring or other non-senile factors.

When should H02.035 be used instead of related codes?

H02.035 should be used when the diagnosis is specifically senile entropion of the left lower eyelid. If the condition is bilateral or affects a different eyelid, other codes should be selected.

What documentation supports H02.035?

Documentation should include a detailed history of the patient's symptoms, a physical examination of the eyelids, and any diagnostic tests performed to assess ocular health and tear film stability.