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ICD-10 Guide
ICD-10 CodesH02.114

H02.114

Billable

Cicatricial ectropion of left upper eyelid

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

Code Description

ICD-10 H02.114 is a billable code used to indicate a diagnosis of cicatricial ectropion of left upper eyelid.

Key Diagnostic Point:

Cicatricial ectropion of the left upper eyelid is characterized by the outward turning of the eyelid margin due to scarring, which can result from trauma, surgery, or inflammatory conditions. The eyelid anatomy involved includes the skin, orbicularis oculi muscle, and conjunctiva. Clinically, patients may present with symptoms such as exposure keratitis, tearing, and cosmetic concerns. The disease progression can lead to chronic irritation and potential vision impairment if left untreated. Diagnostic considerations include a thorough history and physical examination, often supplemented by slit-lamp examination to assess the ocular surface and eyelid position. In some cases, imaging studies may be warranted to evaluate underlying structures or associated conditions. Treatment typically involves surgical intervention to correct the eyelid position and address the underlying scarring, along with potential adjunctive therapies to manage symptoms and prevent recurrence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a detailed assessment of eyelid position and ocular surface health.
  • Treatment complexity: Surgical correction may be necessary, with varying techniques based on the severity of ectropion.
  • Documentation requirements: Comprehensive documentation of symptoms, examination findings, and treatment plans is essential.
  • Coding specificity: Requires precise coding to differentiate from other types of ectropion and eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the eyelid affected or confusion with non-cicatricial ectropion.
  • Documentation gaps: Incomplete records of the patient's history or treatment plan can lead to denials.
  • Billing challenges: Potential for denials if the surgical procedure is not clearly linked to the diagnosis.

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

Cicatricial ectropion can significantly affect a patient's quality of life, leading to discomfort, cosmetic concerns, and potential vision impairment. Understanding the epidemiology of eyelid disorders, including cicatricial ectropion, is crucial for healthcare providers to implement effective management strategies. This condition may be more prevalent in populations with a history of trauma or surgery around the eyes, highlighting the need for targeted interventions and preventive measures in at-risk groups.

ICD-9 vs ICD-10

Cicatricial ectropion can significantly affect a patient's quality of life, leading to discomfort, cosmetic concerns, and potential vision impairment. Understanding the epidemiology of eyelid disorders, including cicatricial ectropion, is crucial for healthcare providers to implement effective management strategies. This condition may be more prevalent in populations with a history of trauma or surgery around the eyes, highlighting the need for targeted interventions and preventive measures in at-risk groups.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the surgery and the payer's policies. Common denials can occur if the documentation does not clearly support the medical necessity of the procedure. It is essential to include pre-operative assessments, surgical notes, and post-operative care details to ensure a smooth billing process. Coding best practices include using the most specific codes available and ensuring that all services rendered are appropriately linked to the diagnosis.

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 H02.114?

H02.114 specifically covers cicatricial ectropion of the left upper eyelid, which is caused by scarring from various etiologies such as trauma, surgery, or chronic inflammatory conditions. It is important to differentiate this from other forms of ectropion, such as involutional ectropion, which is age-related.

When should H02.114 be used instead of related codes?

H02.114 should be used when the ectropion is specifically due to cicatricial changes affecting the left upper eyelid. If the ectropion is due to other causes, such as involutional or mechanical factors, different codes should be selected.

What documentation supports H02.114?

Documentation should include a detailed history of the patient's eyelid condition, examination findings indicating cicatricial changes, and any relevant imaging studies. Surgical notes and treatment plans should clearly outline the relationship between the diagnosis and the procedures performed.