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ICD-10 Guide
ICD-10 CodesH02.216

H02.216

Billable

Cicatricial lagophthalmos left eye, unspecified eyelid

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

Code Description

ICD-10 H02.216 is a billable code used to indicate a diagnosis of cicatricial lagophthalmos left eye, unspecified eyelid.

Key Diagnostic Point:

Cicatricial lagophthalmos of the left eye, involving the unspecified eyelid, is characterized by the inability to fully close the eyelid due to scarring or contracture. This condition often arises from trauma, surgical interventions, or inflammatory diseases that lead to eyelid deformities. The eyelids play a crucial role in protecting the ocular surface, maintaining moisture, and facilitating tear distribution. In cicatricial lagophthalmos, the affected eyelid may exhibit signs of retraction or scarring, which can lead to exposure keratitis, dry eye syndrome, and potential vision impairment. Disease progression may vary, with some patients experiencing worsening symptoms over time, particularly if the underlying cause is not addressed. Diagnostic considerations include a thorough ocular examination, patient history, and possibly imaging studies to assess the extent of eyelid involvement and associated ocular surface damage. Management may involve surgical correction, lubricating eye drops, or other therapeutic interventions to restore eyelid function and protect the eye.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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 lagophthalmos can significantly affect a patient's quality of life, leading to discomfort, visual impairment, and increased healthcare utilization due to complications such as corneal exposure. Understanding the epidemiology of this condition is crucial, as it may be more prevalent in populations with higher rates of trauma or autoimmune diseases. Quality measures should focus on timely diagnosis and effective management to prevent long-term ocular complications.

ICD-9 vs ICD-10

Cicatricial lagophthalmos can significantly affect a patient's quality of life, leading to discomfort, visual impairment, and increased healthcare utilization due to complications such as corneal exposure. Understanding the epidemiology of this condition is crucial, as it may be more prevalent in populations with higher rates of trauma or autoimmune diseases. Quality measures should focus on timely diagnosis and effective management to prevent long-term ocular complications.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the medical necessity of procedures performed, as well as ensuring that all relevant modifiers are applied correctly. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include maintaining clear communication with payers and ensuring that all clinical notes reflect the patient's condition and treatment rationale.

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 H02.216?

H02.216 specifically covers cicatricial lagophthalmos of the left eye, which may result from conditions such as burns, surgical scars, or autoimmune disorders that affect eyelid integrity.

When should H02.216 be used instead of related codes?

H02.216 should be used when the left eyelid is specifically affected by cicatricial lagophthalmos, distinguishing it from right eyelid involvement or other forms of eyelid dysfunction.

What documentation supports H02.216?

Documentation should include a detailed patient history, clinical examination findings, photographs of the eyelid, and any relevant imaging studies that demonstrate the extent of eyelid scarring.