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ICD-10 Guide
ICD-10 CodesH02.221

H02.221

Billable

Mechanical lagophthalmos right upper eyelid

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

Code Description

ICD-10 H02.221 is a billable code used to indicate a diagnosis of mechanical lagophthalmos right upper eyelid.

Key Diagnostic Point:

Mechanical lagophthalmos of the right upper eyelid is characterized by the inability to completely close the eyelid, leading to exposure of the cornea and potential complications such as dryness, irritation, and corneal ulceration. This condition often arises from mechanical factors, such as scarring, eyelid malposition, or anatomical abnormalities affecting eyelid function. The anatomy involved includes the orbicularis oculi muscle, which is responsible for eyelid closure, and the surrounding periocular structures, including the conjunctiva and lacrimal system, which play crucial roles in maintaining ocular surface health. Disease progression can lead to chronic exposure keratopathy, necessitating timely intervention to prevent irreversible corneal damage. Diagnostic considerations include a thorough clinical examination, assessment of eyelid function, and possibly imaging studies to evaluate underlying anatomical issues. Treatment may involve surgical correction, lubricating eye drops, or other supportive measures to protect the cornea and restore eyelid function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of eyelid anatomy and function.
  • Treatment complexity: May involve surgical and non-surgical interventions.
  • Documentation requirements: Detailed clinical notes and possibly imaging results needed.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected eyelid.
  • Documentation gaps: Incomplete clinical assessments or lack of imaging documentation.
  • Billing challenges: Potential denials due to insufficient evidence of medical necessity.

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

The clinical significance of H02.221 lies in its potential to cause corneal exposure and damage, which can lead to vision impairment if untreated. Population health impact includes the need for timely intervention to prevent complications, particularly in at-risk groups such as those with prior eyelid surgery or trauma. Quality measures may focus on the effectiveness of treatment in restoring eyelid function and protecting ocular health, while healthcare utilization patterns may reflect the need for both surgical and non-surgical management options.

ICD-9 vs ICD-10

The clinical significance of H02.221 lies in its potential to cause corneal exposure and damage, which can lead to vision impairment if untreated. Population health impact includes the need for timely intervention to prevent complications, particularly in at-risk groups such as those with prior eyelid surgery or trauma. Quality measures may focus on the effectiveness of treatment in restoring eyelid function and protecting ocular health, while healthcare utilization patterns may reflect the need for both surgical and non-surgical management options.

Reimbursement & Billing Impact

Reimbursement considerations may vary by payer, so it is essential to verify coverage policies. Common denials can occur if documentation does not clearly establish the medical necessity for treatment or if the coding does not accurately reflect the condition. Best practices include maintaining thorough clinical notes, ensuring all relevant procedures are coded, and following up on any claims that are denied to address potential issues promptly.

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 H02.221?

H02.221 specifically covers mechanical lagophthalmos of the right upper eyelid, which may result from conditions such as eyelid trauma, scarring, or congenital malformations affecting eyelid closure.

When should H02.221 be used instead of related codes?

H02.221 should be used when the condition specifically involves mechanical lagophthalmos of the right upper eyelid, distinguishing it from similar conditions affecting the left eyelid or other eyelid disorders.

What documentation supports H02.221?

Documentation should include a detailed clinical examination of eyelid function, any relevant imaging studies, and a description of the mechanical factors contributing to lagophthalmos, along with treatment plans.