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ICD-10 Guide
ICD-10 CodesH02.036

H02.036

Billable

Senile entropion of left eye, unspecified eyelid

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

Code Description

ICD-10 H02.036 is a billable code used to indicate a diagnosis of senile entropion of left eye, unspecified eyelid.

Key Diagnostic Point:

Senile entropion of the left eye, unspecified 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 the eyelashes rubbing against the ocular surface. This condition is commonly seen in older adults due to age-related changes in the eyelid's structural integrity, including laxity of the eyelid skin and weakening of the supporting tissues. The anatomy involved includes the eyelids, which consist of skin, muscle, and connective tissue, as well as the lacrimal system responsible for tear production and drainage. Disease progression may lead to chronic irritation, redness, tearing, and potential corneal damage if left untreated. Diagnostic considerations include a thorough eye examination, patient history, and assessment of symptoms such as discomfort, tearing, and visual disturbances. Treatment options may range from conservative management, 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 clinical evaluation and differentiation from other eyelid disorders.
  • Treatment complexity: May involve surgical procedures, necessitating pre-operative assessments.
  • Documentation requirements: Detailed documentation of symptoms and treatment plans is essential.
  • Coding specificity: Specific to senile entropion of the left eye, which aids in accurate coding.

Audit Risk Factors

  • Common coding errors: Misidentification of the eye affected or confusion with other eyelid conditions.
  • Documentation gaps: Inadequate symptom description or lack of treatment rationale.
  • 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

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

Senile entropion significantly impacts the quality of life for affected individuals, leading to discomfort and potential vision impairment. Understanding the epidemiology of this condition is crucial, as it is prevalent in the aging population. Effective management can reduce healthcare utilization by preventing complications such as corneal abrasions or infections, thus improving overall patient outcomes and quality measures in ophthalmic care.

ICD-9 vs ICD-10

Senile entropion significantly impacts the quality of life for affected individuals, leading to discomfort and potential vision impairment. Understanding the epidemiology of this condition is crucial, as it is prevalent in the aging population. Effective management can reduce healthcare utilization by preventing complications such as corneal abrasions or infections, thus improving overall patient outcomes and quality measures in ophthalmic care.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure performed, whether it was surgical or non-surgical, and the patient's insurance coverage. Common denials may arise from insufficient documentation or lack of medical necessity. Best practices include ensuring that all clinical notes are thorough and that the rationale for treatment is clearly articulated to support the coding.

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 H02.036?

H02.036 specifically covers senile entropion affecting the left eyelid, which is characterized by the inward turning of the eyelid margin in older adults. It does not cover entropion due to other causes such as scarring or congenital factors.

When should H02.036 be used instead of related codes?

H02.036 should be used when the diagnosis is specifically senile entropion of the left eyelid. If the condition affects the right eyelid, H02.035 should be used. Additionally, if the entropion is due to other causes, different codes should be selected.

What documentation supports H02.036?

Documentation should include a detailed patient history, clinical findings from the eye examination, symptoms experienced by the patient, and any treatment plans or interventions undertaken. Photographic evidence may also be beneficial.