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ICD-10 Guide
ICD-10 CodesH02.206

H02.206

Billable

Unspecified lagophthalmos left eye, unspecified eyelid

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

Code Description

ICD-10 H02.206 is a billable code used to indicate a diagnosis of unspecified lagophthalmos left eye, unspecified eyelid.

Key Diagnostic Point:

Lagophthalmos is a condition characterized by the inability to completely close the eyelids, which can lead to exposure of the cornea and subsequent complications such as dryness, irritation, and potential corneal damage. In the case of unspecified lagophthalmos of the left eye, the condition may arise from various etiologies, including neurological disorders (e.g., Bell's palsy), trauma, or congenital anomalies affecting the eyelid structure. The anatomy involved includes the eyelids, which consist of the upper and lower eyelids, and their associated muscles, particularly the orbicularis oculi, which is responsible for eyelid closure. The lacrimal system, which produces and drains tears, may also be affected, leading to inadequate lubrication of the ocular surface. Disease progression can vary; if left untreated, lagophthalmos can result in severe ocular complications, including keratitis and even vision loss. Diagnostic considerations include a thorough clinical examination, assessment of eyelid function, and possibly imaging studies to evaluate underlying causes. Treatment may involve lubricating eye drops, eyelid weights, or surgical intervention to restore eyelid closure.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of underlying causes and potential complications.
  • Treatment complexity: Management may involve both conservative and surgical options.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the eye affected or misclassification of the condition.
  • Documentation gaps: Incomplete clinical notes that do not adequately describe the condition.
  • Billing challenges: Potential denials if the medical necessity for treatment is not clearly documented.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Lagophthalmos can significantly impact a patient's quality of life due to discomfort and potential vision loss. It is essential for healthcare providers to recognize and address this condition promptly to prevent complications. Understanding the epidemiology of lagophthalmos, particularly in populations with higher incidences of neurological disorders or trauma, can inform public health strategies and resource allocation. Quality measures should focus on timely diagnosis and effective management to improve patient outcomes.

ICD-9 vs ICD-10

Lagophthalmos can significantly impact a patient's quality of life due to discomfort and potential vision loss. It is essential for healthcare providers to recognize and address this condition promptly to prevent complications. Understanding the epidemiology of lagophthalmos, particularly in populations with higher incidences of neurological disorders or trauma, can inform public health strategies and resource allocation. Quality measures should focus on timely diagnosis and effective management to improve patient outcomes.

Reimbursement & Billing Impact

reimbursement and to utilize appropriate modifiers when necessary to indicate the specifics of the treatment provided.

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 H02.206?

H02.206 covers unspecified lagophthalmos of the left eye, which may result from various conditions such as facial nerve paralysis, trauma, or congenital defects affecting eyelid closure.

When should H02.206 be used instead of related codes?

H02.206 should be used when the lagophthalmos is specifically noted as affecting the left eye and no further specification of the cause is provided. If the cause is known, more specific codes may be appropriate.

What documentation supports H02.206?

Documentation should include a detailed clinical assessment of eyelid function, any neurological evaluations, and treatment plans that justify the diagnosis of lagophthalmos affecting the left eye.