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ICD-10 Guide
ICD-10 CodesH02.104

H02.104

Billable

Unspecified ectropion of left upper eyelid

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

Code Description

ICD-10 H02.104 is a billable code used to indicate a diagnosis of unspecified ectropion of left upper eyelid.

Key Diagnostic Point:

Unspecified ectropion of the left upper eyelid is characterized by the outward turning of the eyelid margin, leading to exposure of the conjunctiva and potential complications such as dryness, irritation, and increased risk of infection. The eyelid anatomy includes the skin, muscle, and connective tissue that support eyelid function, which is crucial for protecting the eye and maintaining tear film stability. Ectropion can result from various factors, including age-related changes, scarring, or neurological conditions. The disease progression may lead to chronic conjunctivitis or keratitis if left untreated. Diagnosis typically involves a thorough clinical examination, including assessment of eyelid position, tear production, and ocular surface health. Diagnostic imaging may be warranted in cases where underlying structural abnormalities are suspected. Understanding the lacrimal system's role is essential, as ectropion can disrupt normal tear drainage, exacerbating ocular symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate due to the need for differential diagnosis and assessment of underlying causes.
  • Treatment complexity: Varies from conservative management to surgical intervention depending on severity.
  • Documentation requirements: Requires detailed clinical notes regarding symptoms, examination findings, and treatment plans.
  • Coding specificity: Moderate specificity as it pertains to the left upper eyelid but lacks detail on the underlying cause.

Audit Risk Factors

  • Common coding errors: Misidentification of eyelid location or type of ectropion.
  • Documentation gaps: Incomplete clinical notes regarding symptoms or treatment rationale.
  • Billing challenges: Potential for denials if documentation does not support the diagnosis or if the condition is not clearly specified.

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

Ectropion can significantly affect a patient's quality of life, leading to discomfort and potential complications such as chronic conjunctivitis. Understanding the prevalence of eyelid disorders like ectropion is crucial for population health, as they can lead to increased healthcare utilization due to associated ocular symptoms. Quality measures may include the assessment of patient-reported outcomes related to eyelid function and ocular comfort.

ICD-9 vs ICD-10

Ectropion can significantly affect a patient's quality of life, leading to discomfort and potential complications such as chronic conjunctivitis. Understanding the prevalence of eyelid disorders like ectropion is crucial for population health, as they can lead to increased healthcare utilization due to associated ocular symptoms. Quality measures may include the assessment of patient-reported outcomes related to eyelid function and ocular comfort.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the medical necessity of the treatment provided, whether conservative or surgical. Common denials may arise from insufficient documentation or failure to demonstrate the impact of the condition on the patient's quality of life. Best practices include maintaining thorough clinical notes and ensuring that all relevant symptoms and treatment rationales are documented to support the claim.

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 H02.104?

H02.104 covers unspecified ectropion of the left upper eyelid, which may arise from various etiologies such as age-related changes, trauma, or neurological disorders. It is important to differentiate it from other eyelid conditions like entropion or eyelid retraction.

When should H02.104 be used instead of related codes?

H02.104 should be used when the ectropion is specifically noted as affecting the left upper eyelid without further specification of the underlying cause. If the cause is known, a more specific code should be selected.

What documentation supports H02.104?

Documentation should include a detailed history of the patient's symptoms, a comprehensive eye examination noting the eyelid position, any associated ocular symptoms, and the rationale for the diagnosis of ectropion.