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ICD-10 Guide
ICD-10 CodesH02.219

H02.219

Billable

Cicatricial lagophthalmos unspecified eye, unspecified eyelid

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

Code Description

ICD-10 H02.219 is a billable code used to indicate a diagnosis of cicatricial lagophthalmos unspecified eye, unspecified eyelid.

Key Diagnostic Point:

Cicatricial lagophthalmos is a condition characterized by the inability to fully close the eyelids due to scarring, which can occur in either eye or both. This condition often results from trauma, surgical interventions, or inflammatory diseases affecting the eyelids. The anatomy involved includes the eyelids, which are composed of skin, muscle, and connective tissue, and the orbicularis oculi muscle, responsible for eyelid closure. The lacrimal system may also be affected, leading to inadequate tear distribution and potential exposure keratopathy. Disease progression can lead to chronic irritation, corneal damage, and visual impairment if not addressed. Diagnostic considerations include a thorough clinical examination, patient history, and possibly imaging studies to assess the extent of scarring and associated ocular surface conditions. Treatment options may involve surgical repair, lubricating eye drops, or other interventions to improve eyelid function and protect the cornea.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful assessment of eyelid function and associated conditions.
  • Treatment complexity: May involve surgical and non-surgical approaches, necessitating multidisciplinary care.
  • Documentation requirements: Detailed clinical notes and imaging may be needed to justify the diagnosis.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misclassification of the condition due to lack of specificity.
  • Documentation gaps: Incomplete clinical notes may lead to denials or audits.
  • Billing challenges: Difficulty in obtaining reimbursement due to vague coding.

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 patient quality of life by causing discomfort, visual impairment, and increased risk of corneal damage. Understanding the epidemiology of this condition is crucial, as it may arise from various underlying causes, including trauma and surgical complications. Effective management can improve patient outcomes and reduce healthcare utilization by preventing complications associated with untreated lagophthalmos.

ICD-9 vs ICD-10

Cicatricial lagophthalmos can significantly impact patient quality of life by causing discomfort, visual impairment, and increased risk of corneal damage. Understanding the epidemiology of this condition is crucial, as it may arise from various underlying causes, including trauma and surgical complications. Effective management can improve patient outcomes and reduce healthcare utilization by preventing complications associated with untreated lagophthalmos.

Reimbursement & Billing Impact

reimbursement. Common denials may arise from insufficient documentation or lack of specificity in coding. It is essential to use appropriate CPT codes for any surgical interventions or procedures performed, and to follow payer-specific guidelines for billing to minimize the risk of denials.

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 H02.219?

H02.219 covers cicatricial lagophthalmos due to scarring from various causes, including trauma, surgery, or inflammatory conditions affecting the eyelids, without specifying which eye is involved.

When should H02.219 be used instead of related codes?

H02.219 should be used when the specific eye affected is not documented, or when the condition is bilateral and unspecified. It is important to choose more specific codes when the eye involved is known.

What documentation supports H02.219?

Documentation should include a detailed clinical examination, patient history indicating the cause of lagophthalmos, and any imaging studies that support the diagnosis of cicatricial changes in the eyelids.