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ICD-10 Guide
ICD-10 CodesH02.043

H02.043

Billable

Spastic entropion of right eye, unspecified eyelid

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

Code Description

ICD-10 H02.043 is a billable code used to indicate a diagnosis of spastic entropion of right eye, unspecified eyelid.

Key Diagnostic Point:

Spastic entropion of the right eye, unspecified eyelid, is characterized by an involuntary spasm 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, discomfort, 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 can vary; if left untreated, spastic entropion may lead to chronic irritation, corneal abrasions, and even vision loss. Diagnostic considerations include a thorough ocular examination to assess eyelid position and function, as well as the evaluation of any underlying neurological conditions that may contribute to muscle spasms. Treatment options may include conservative measures such as lubricating eye drops, botulinum toxin injections to reduce muscle spasm, or surgical intervention to correct the eyelid position.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive eye examination and possibly neurological evaluation.
  • Treatment complexity: May involve multiple treatment modalities, including surgical options.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other forms of entropion and eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the eyelid involved or confusion with other eyelid disorders.
  • Documentation gaps: Incomplete clinical notes that do not adequately describe the condition or treatment rationale.
  • Billing challenges: Potential denials if the documentation does not support the medical necessity of the 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

Neurology

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

The clinical significance of spastic entropion lies in its potential to cause discomfort and vision impairment due to corneal irritation. Population health impact includes the need for timely diagnosis and treatment to prevent complications, particularly in older adults who may be more susceptible. Quality measures may focus on the effectiveness of treatment interventions and patient-reported outcomes. Understanding healthcare utilization patterns related to this condition can aid in resource allocation and improve patient care strategies.

ICD-9 vs ICD-10

The clinical significance of spastic entropion lies in its potential to cause discomfort and vision impairment due to corneal irritation. Population health impact includes the need for timely diagnosis and treatment to prevent complications, particularly in older adults who may be more susceptible. Quality measures may focus on the effectiveness of treatment interventions and patient-reported outcomes. Understanding healthcare utilization patterns related to this condition can aid in resource allocation and improve patient care strategies.

Reimbursement & Billing Impact

Reimbursement considerations include the medical necessity of procedures performed, particularly if surgical intervention is required. Common denials may arise if documentation does not clearly establish the diagnosis or if the treatment is deemed not medically necessary. Coders should ensure that all relevant clinical information is included in the patient's record to facilitate smooth billing processes and minimize 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 H02.043?

H02.043 specifically covers spastic entropion of the right eye, which is characterized by involuntary eyelid muscle spasms causing inward turning of the eyelid. It does not cover other forms of entropion or eyelid disorders such as involutional entropion or cicatricial entropion.

When should H02.043 be used instead of related codes?

H02.043 should be used when the spastic entropion specifically affects the right eyelid. If the left eyelid is affected, H02.041 should be used, and if both eyelids are involved, H02.042 is appropriate. Accurate coding is essential for proper treatment and reimbursement.

What documentation supports H02.043?

Documentation should include a detailed clinical examination report, noting the presence of spastic entropion, any associated symptoms, and the treatment plan. Evidence of the impact on vision or quality of life may also support the medical necessity for treatment.