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ICD-10 Guide
ICD-10 CodesH02.115

H02.115

Billable

Cicatricial ectropion of left lower eyelid

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

Code Description

ICD-10 H02.115 is a billable code used to indicate a diagnosis of cicatricial ectropion of left lower eyelid.

Key Diagnostic Point:

Cicatricial ectropion of the left lower 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, which may become exposed and irritated due to the ectropion. Clinically, patients may present with symptoms such as tearing, irritation, and exposure keratitis, as the eyelid fails to adequately cover the eye. Disease progression can lead to chronic discomfort, corneal damage, and potential vision impairment if left untreated. Diagnostic considerations include a thorough history and physical examination, with attention to the eyelid's position, associated symptoms, and any underlying conditions contributing to scarring. Additional imaging or referral to an ophthalmologist may be warranted for comprehensive evaluation and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of eyelid anatomy and potential underlying causes.
  • Treatment complexity: May involve surgical intervention or conservative management depending on severity.
  • Documentation requirements: Detailed clinical notes necessary to justify the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other types of ectropion.

Audit Risk Factors

  • Common coding errors: Misidentification of ectropion type or laterality.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis.
  • Billing challenges: Potential denials if the medical necessity is not clearly established.

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 and potential vision issues. Understanding the epidemiology of eyelid disorders, including cicatricial ectropion, is essential for healthcare providers to address population health needs effectively. Quality measures related to eyelid surgeries and patient outcomes can help improve healthcare utilization patterns and ensure better management of these conditions.

ICD-9 vs ICD-10

Cicatricial ectropion can significantly affect a patient's quality of life, leading to discomfort and potential vision issues. Understanding the epidemiology of eyelid disorders, including cicatricial ectropion, is essential for healthcare providers to address population health needs effectively. Quality measures related to eyelid surgeries and patient outcomes can help improve healthcare utilization patterns and ensure better management of these conditions.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the case and the treatment provided. Common denials can occur if the documentation does not clearly establish the diagnosis or if the procedure is deemed not medically necessary. Coders should ensure that all relevant clinical information is included in the medical record to support the claim and facilitate appropriate reimbursement.

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 H02.115?

H02.115 specifically covers cicatricial ectropion of the left lower eyelid, which may arise from conditions such as trauma, surgical scarring, or chronic inflammatory diseases that affect the eyelid's structural integrity.

When should H02.115 be used instead of related codes?

H02.115 should be used when the ectropion is specifically due to scarring of the left lower eyelid. It is important to differentiate it from other types of ectropion, such as involutional or paralytic ectropion, which have different underlying causes and management strategies.

What documentation supports H02.115?

Documentation should include a detailed clinical examination noting the eyelid's position, any associated symptoms, and the history of the scarring. Photographic evidence and notes on the impact on vision or quality of life can further support the diagnosis.