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ICD-10 Guide
ICD-10 CodesH02.222

H02.222

Billable

Mechanical lagophthalmos right lower eyelid

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

Code Description

ICD-10 H02.222 is a billable code used to indicate a diagnosis of mechanical lagophthalmos right lower eyelid.

Key Diagnostic Point:

Mechanical lagophthalmos of the right lower eyelid is characterized by the inability to completely close the eyelid due to mechanical obstruction or structural abnormalities. This condition can arise from various etiologies, including trauma, scarring, or anatomical malformations affecting the eyelid's ability to function properly. The eyelid anatomy includes the skin, muscle (orbicularis oculi), and connective tissue, all of which play critical roles in eyelid closure and protection of the ocular surface. In mechanical lagophthalmos, the lower eyelid may be affected by conditions such as ptosis, eyelid retraction, or scarring from previous surgeries or injuries. The clinical presentation may include exposure keratitis, dryness, and irritation of the cornea, leading to potential complications such as corneal ulcers. Diagnosis typically involves a thorough clinical examination, including assessment of eyelid movement and function, and may require imaging studies to evaluate underlying structural issues. Treatment options may vary from conservative management, such as lubricating eye drops, to surgical interventions aimed at restoring eyelid function and protecting the ocular surface.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough assessment of eyelid function and potential underlying causes.
  • Treatment complexity: May involve both medical and surgical management depending on severity.
  • Documentation requirements: Detailed clinical notes are necessary to support diagnosis and treatment.
  • Coding specificity: Requires precise coding to differentiate from other eyelid disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected eyelid or confusion with other eyelid disorders.
  • Documentation gaps: Incomplete clinical notes regarding the cause and impact of lagophthalmos.
  • Billing challenges: Potential for denials if documentation does not clearly support the diagnosis.

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 H02.222 lies in its potential to cause ocular surface damage and compromise visual function if left untreated. Population health impact includes the need for timely intervention to prevent complications such as corneal ulcers, which can lead to more severe outcomes. Quality measures may focus on the effectiveness of treatment interventions and patient satisfaction with ocular health. Understanding healthcare utilization patterns related to this condition can help in resource allocation and improving patient care strategies.

ICD-9 vs ICD-10

The clinical significance of H02.222 lies in its potential to cause ocular surface damage and compromise visual function if left untreated. Population health impact includes the need for timely intervention to prevent complications such as corneal ulcers, which can lead to more severe outcomes. Quality measures may focus on the effectiveness of treatment interventions and patient satisfaction with ocular health. Understanding healthcare utilization patterns related to this condition can help in resource allocation and improving patient care strategies.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the medical necessity of treatments and ensuring that all documentation aligns with the diagnosis. Common denials may occur if the documentation does not sufficiently support the diagnosis of mechanical lagophthalmos or if the treatment provided is not clearly justified. Best practices include maintaining thorough records of patient assessments, treatment responses, and any follow-up care provided.

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 H02.222?

H02.222 specifically covers mechanical lagophthalmos of the right lower eyelid, which may result from trauma, surgical scarring, or congenital anomalies affecting eyelid closure.

When should H02.222 be used instead of related codes?

H02.222 should be used when the diagnosis specifically involves mechanical lagophthalmos of the right lower eyelid, distinguishing it from left-sided or other types of lagophthalmos.

What documentation supports H02.222?

Documentation should include a detailed clinical examination, assessment of eyelid function, and any imaging studies performed to evaluate the underlying cause of the mechanical lagophthalmos.