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ICD-10 Guide
ICD-10 CodesH02.215

H02.215

Billable

Cicatricial lagophthalmos left lower eyelid

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

Code Description

ICD-10 H02.215 is a billable code used to indicate a diagnosis of cicatricial lagophthalmos left lower eyelid.

Key Diagnostic Point:

Cicatricial lagophthalmos of the left lower eyelid is a condition characterized by incomplete closure of the eyelid due to scarring or fibrosis, which may result from trauma, surgery, or inflammatory conditions. The left lower eyelid anatomy includes the skin, orbicularis oculi muscle, and underlying connective tissue, which are essential for eyelid function and protection of the ocular surface. In cicatricial lagophthalmos, the scarring can lead to exposure keratopathy, where the cornea becomes dry and damaged due to inadequate lubrication and protection. Disease progression may involve worsening ocular surface health, leading to potential complications such as corneal ulcers or infections. Diagnosis typically involves a thorough clinical examination, assessment of eyelid function, and possibly imaging studies to evaluate the extent of scarring. Treatment options may include surgical intervention to release the scar tissue, eyelid weights, or other supportive measures to enhance eyelid closure and protect the eye. Regular follow-up is crucial to monitor for complications and ensure optimal ocular health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a detailed clinical assessment and understanding of eyelid anatomy.
  • Treatment complexity: May involve surgical and non-surgical interventions.
  • Documentation requirements: Requires thorough documentation of clinical findings and treatment plans.
  • Coding specificity: Specific to cicatricial lagophthalmos, necessitating accurate coding to reflect the condition.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected eyelid or confusion with other eyelid disorders.
  • Documentation gaps: Incomplete records regarding the cause and extent of scarring.
  • Billing challenges: Potential denials if the condition is not clearly documented or justified.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Cicatricial lagophthalmos can significantly impact a patient's quality of life, leading to discomfort, visual impairment, and increased healthcare utilization due to complications. Understanding the epidemiology of this condition is essential, as it may be more prevalent in populations with a higher incidence of trauma or surgical interventions. Quality measures should focus on timely diagnosis and effective management to prevent complications and improve patient outcomes.

ICD-9 vs ICD-10

Cicatricial lagophthalmos can significantly impact a patient's quality of life, leading to discomfort, visual impairment, and increased healthcare utilization due to complications. Understanding the epidemiology of this condition is essential, as it may be more prevalent in populations with a higher incidence of trauma or surgical interventions. Quality measures should focus on timely diagnosis and effective management to prevent complications and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the need for pre-authorization for surgical procedures and ensuring that all documentation supports the medical necessity of the treatment. Common denials may 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 notes, imaging results, and treatment plans are included in the patient’s medical record to support claims.

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 H02.215?

H02.215 specifically covers cicatricial lagophthalmos of the left lower eyelid, which may arise from conditions such as trauma, surgical scarring, or chronic inflammatory diseases affecting the eyelid.

When should H02.215 be used instead of related codes?

H02.215 should be used when the clinical presentation specifically involves cicatricial lagophthalmos of the left lower eyelid, distinguishing it from other eyelid disorders or lagophthalmos affecting different eyelids.

What documentation supports H02.215?

Documentation should include a detailed clinical examination, history of eyelid trauma or surgery, assessment of eyelid closure, and any imaging studies that support the diagnosis of cicatricial lagophthalmos.