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ICD-10 Guide
ICD-10 CodesH02.35

H02.35

Billable

Blepharochalasis left lower eyelid

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

Code Description

ICD-10 H02.35 is a billable code used to indicate a diagnosis of blepharochalasis left lower eyelid.

Key Diagnostic Point:

Blepharochalasis of the left lower eyelid is characterized by the recurrent swelling and subsequent relaxation of the eyelid skin, leading to excess skin and a drooping appearance. This condition primarily affects the lower eyelid, resulting from repeated episodes of edema and inflammation, which can be associated with allergic reactions, systemic diseases, or idiopathic causes. The anatomy involved includes the eyelid structure, which consists of skin, muscle (orbicularis oculi), and connective tissue, as well as the underlying lacrimal system that may be affected by the condition. Disease progression can lead to cosmetic concerns and potential functional impairment, such as obstructed vision due to eyelid droop. Diagnostic considerations include a thorough patient history, physical examination, and possibly imaging studies to rule out underlying causes. The condition is often diagnosed clinically, and treatment options may include surgical intervention for severe cases or conservative management for mild presentations.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other eyelid disorders such as ptosis or dermatochalasis.
  • Treatment complexity: May involve surgical procedures, which require careful planning and patient selection.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to ensure accurate representation of the condition.

Audit Risk Factors

  • Common coding errors: Misuse of related codes or incorrect laterality.
  • Documentation gaps: Lack of detailed clinical notes to support the diagnosis.
  • Billing challenges: Potential denials if the necessity for surgical intervention 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

Blepharochalasis can significantly affect a patient's quality of life, leading to psychological distress and social withdrawal due to cosmetic concerns. The condition may also impact healthcare utilization patterns, as patients seek surgical correction to restore function and appearance. Understanding the epidemiology of blepharochalasis is essential for healthcare providers, as it can inform population health strategies and quality measures aimed at improving patient outcomes.

ICD-9 vs ICD-10

Blepharochalasis can significantly affect a patient's quality of life, leading to psychological distress and social withdrawal due to cosmetic concerns. The condition may also impact healthcare utilization patterns, as patients seek surgical correction to restore function and appearance. Understanding the epidemiology of blepharochalasis is essential for healthcare providers, as it can inform population health strategies and quality measures aimed at improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of surgery for functional impairment or cosmetic reasons. Common denials may arise if the documentation does not clearly justify the need for intervention. Coders should ensure that all relevant clinical notes, including pre-operative assessments and post-operative care, are included to support the claim. Best practices involve using precise coding and maintaining thorough records to facilitate smooth billing processes.

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 H02.35?

H02.35 specifically covers blepharochalasis of the left lower eyelid, which may be associated with recurrent eyelid swelling and excess skin. It does not cover other eyelid conditions such as ptosis or dermatochalasis unless specified.

When should H02.35 be used instead of related codes?

H02.35 should be used when the condition specifically affects the left lower eyelid and is characterized by the features of blepharochalasis. It is important to differentiate it from other eyelid disorders based on clinical findings.

What documentation supports H02.35?

Documentation should include a detailed history of the patient's symptoms, clinical examination findings, and any relevant imaging studies. Notes should clearly indicate the diagnosis of blepharochalasis and the impact on the patient's function or quality of life.