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ICD-10 Guide
ICD-10 CodesH02.042

H02.042

Billable

Spastic entropion of right lower eyelid

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

Code Description

ICD-10 H02.042 is a billable code used to indicate a diagnosis of spastic entropion of right lower eyelid.

Key Diagnostic Point:

Spastic entropion of the right lower eyelid is characterized by an involuntary contraction of the eyelid muscles, leading to the inward turning of the eyelid margin. This condition can cause the eyelashes to rub against the cornea, resulting in irritation, redness, and potential damage to the ocular surface. The anatomy involved includes the orbicularis oculi muscle, which is responsible for eyelid closure, and the surrounding periocular structures, including the conjunctiva and cornea. Disease progression may vary; if left untreated, spastic entropion can lead to chronic discomfort, corneal abrasions, and even vision impairment. Diagnostic considerations include a thorough ocular examination, assessment of eyelid position, and evaluation of any associated symptoms such as tearing or foreign body sensation. Treatment options may involve botulinum toxin injections to relax the spastic muscle or surgical intervention to correct the eyelid position, depending on the severity and underlying causes of the condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a detailed ocular examination and understanding of eyelid anatomy.
  • Treatment complexity: May involve both non-surgical and surgical options, necessitating careful patient selection.
  • Documentation requirements: Comprehensive documentation of symptoms, examination findings, and treatment plans is essential.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the eyelid involved or confusion with other forms of entropion.
  • Documentation gaps: Incomplete records regarding the patient's symptoms and treatment history.
  • Billing challenges: Potential denials if the medical necessity is not clearly 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

Spastic entropion can significantly impact a patient's quality of life, leading to discomfort and potential vision issues. Understanding the epidemiology of this condition helps healthcare providers identify at-risk populations, particularly among older adults. Quality measures may include tracking the effectiveness of treatments and patient satisfaction. Increased awareness and proper coding can lead to improved healthcare utilization patterns, ensuring that patients receive timely and appropriate care.

ICD-9 vs ICD-10

Spastic entropion can significantly impact a patient's quality of life, leading to discomfort and potential vision issues. Understanding the epidemiology of this condition helps healthcare providers identify at-risk populations, particularly among older adults. Quality measures may include tracking the effectiveness of treatments and patient satisfaction. Increased awareness and proper coding can lead to improved healthcare utilization patterns, ensuring that patients receive timely and appropriate care.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the treatment provided, whether it be surgical repair or botulinum toxin injections. Common denials may arise if the medical necessity is not well-documented or if the procedure does not align with the diagnosis. Coders should ensure that all relevant details, including patient history and treatment rationale, are thoroughly documented to support claims.

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 H02.042?

H02.042 specifically covers spastic entropion of the right lower eyelid, which is characterized by involuntary muscle contractions leading to eyelid inversion. It is essential to differentiate this from other forms of entropion, such as involutional or cicatricial entropion.

When should H02.042 be used instead of related codes?

H02.042 should be used when the condition specifically involves spastic entropion of the right lower eyelid. It is crucial to select this code over related codes when the clinical presentation confirms spasticity as the underlying cause.

What documentation supports H02.042?

Documentation should include a detailed ocular examination, noting the eyelid position, any associated symptoms, and treatment plans. Evidence of the spastic nature of the entropion, such as muscle contraction assessments, should also be included.