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ICD-10 Guide
ICD-10 CodesH02.125

H02.125

Billable

Mechanical ectropion of left lower eyelid

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

Code Description

ICD-10 H02.125 is a billable code used to indicate a diagnosis of mechanical ectropion of left lower eyelid.

Key Diagnostic Point:

Mechanical ectropion of the left lower eyelid is characterized by the outward turning of the eyelid margin, which can lead to exposure of the conjunctiva and cornea. This condition often arises due to mechanical factors such as scarring, trauma, or excessive skin laxity, commonly seen in older adults. The left lower eyelid anatomy includes the skin, orbicularis oculi muscle, tarsal plate, and conjunctiva, all of which play a role in eyelid function and protection of the ocular surface. Disease progression may lead to chronic irritation, tearing, and potential corneal damage if left untreated. Diagnosis typically involves a thorough clinical examination, including assessment of eyelid position, eyelid margin integrity, and ocular surface health. Additional diagnostic tools may include slit-lamp examination and photography to document the condition. Understanding the underlying causes is crucial for effective management and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a detailed clinical evaluation to differentiate from other eyelid disorders.
  • Treatment complexity: May involve surgical intervention or conservative management depending on severity.
  • Documentation requirements: Requires comprehensive documentation of clinical findings and treatment rationale.
  • Coding specificity: Specific to mechanical ectropion, necessitating accurate coding to avoid misclassification.

Audit Risk Factors

  • Common coding errors: Misclassification with other ectropion types or eyelid disorders.
  • Documentation gaps: Incomplete clinical notes regarding the cause and severity of ectropion.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis and 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

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

Mechanical ectropion can significantly affect a patient's quality of life, leading to discomfort, cosmetic concerns, and potential vision impairment. Understanding the epidemiology of this condition is essential, as it is more prevalent in older populations and those with certain risk factors. Addressing ectropion can improve patient outcomes, reduce healthcare utilization related to complications, and enhance overall population health by ensuring timely and appropriate treatment.

ICD-9 vs ICD-10

Mechanical ectropion can significantly affect a patient's quality of life, leading to discomfort, cosmetic concerns, and potential vision impairment. Understanding the epidemiology of this condition is essential, as it is more prevalent in older populations and those with certain risk factors. Addressing ectropion can improve patient outcomes, reduce healthcare utilization related to complications, and enhance overall population health by ensuring timely and appropriate treatment.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the procedure performed, whether surgical intervention is necessary, and the patient's insurance coverage. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Coders should ensure that all relevant clinical details are captured to support the diagnosis and justify the treatment provided, adhering to payer-specific guidelines.

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 H02.125?

H02.125 specifically covers mechanical ectropion of the left lower eyelid, which may result from trauma, scarring, or age-related changes leading to eyelid laxity.

When should H02.125 be used instead of related codes?

H02.125 should be used when the ectropion is specifically due to mechanical factors, distinguishing it from spastic or other types of ectropion which have different underlying causes.

What documentation supports H02.125?

Documentation should include a detailed clinical examination, description of the eyelid position, any underlying conditions contributing to the ectropion, and treatment plans, including any surgical interventions.