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ICD-10 Guide
ICD-10 CodesH02.22

H02.22

Non-billable

Mechanical lagophthalmos

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

Code Description

ICD-10 H02.22 is a used to indicate a diagnosis of mechanical lagophthalmos.

Key Diagnostic Point:

Mechanical lagophthalmos is a condition characterized by the inability to fully close the eyelids, often due to anatomical or mechanical factors such as scarring, eyelid malposition, or other structural abnormalities. The eyelids play a crucial role in protecting the eye, maintaining moisture, and facilitating proper tear distribution. In mechanical lagophthalmos, the affected individual may experience symptoms such as dryness, irritation, and exposure keratitis due to inadequate eyelid closure. The condition can arise from various etiologies, including trauma, surgical interventions, or congenital anomalies. Diagnosis typically involves a thorough clinical examination, including assessment of eyelid function and the presence of any underlying conditions affecting the eyelid or surrounding structures. Diagnostic imaging may be employed to evaluate the orbit and periocular anatomy. Disease progression can lead to significant ocular surface damage if left untreated, necessitating timely intervention. Treatment options may include surgical correction, lubricating eye drops, or protective measures to prevent corneal exposure. Understanding the anatomy of the eyelids, lacrimal system, and orbit is essential for effective management and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Common coding errors include misclassification of the type of lagophthalmos.
  • Documentation gaps may arise if the underlying cause is not clearly stated.
  • Billing challenges can occur if the treatment plan is not well-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

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 lagophthalmos can significantly impact a patient's quality of life, leading to discomfort and potential vision loss if not addressed. The condition is relevant in population health as it may affect individuals with a history of trauma or surgery around the eyes. Quality measures related to eye care and patient outcomes can be influenced by the timely diagnosis and management of lagophthalmos, highlighting the importance of awareness and appropriate coding in healthcare utilization patterns.

ICD-9 vs ICD-10

Mechanical lagophthalmos can significantly impact a patient's quality of life, leading to discomfort and potential vision loss if not addressed. The condition is relevant in population health as it may affect individuals with a history of trauma or surgery around the eyes. Quality measures related to eye care and patient outcomes can be influenced by the timely diagnosis and management of lagophthalmos, highlighting the importance of awareness and appropriate coding in healthcare utilization patterns.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the treatment provided, whether surgical intervention is necessary, and the need for follow-up care. Common denials may arise from insufficient documentation of the underlying cause or the treatment rationale. It is essential to ensure that all relevant clinical notes, imaging results, and treatment plans are included in the patient's medical record to support the billing process and reduce the risk of audit issues.

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 H02.22?

H02.22 specifically covers mechanical lagophthalmos, which can result from conditions such as eyelid scarring, trauma, or congenital malformations that prevent complete eyelid closure.

When should H02.22 be used instead of related codes?

H02.22 should be used when the lagophthalmos is due to mechanical factors rather than neurological causes, such as facial nerve paralysis (H02.21). Accurate differentiation is crucial for appropriate treatment and reimbursement.

What documentation supports H02.22?

Documentation should include a detailed clinical assessment of eyelid function, any relevant imaging studies, and a clear description of the mechanical factors contributing to the lagophthalmos.