ICD-10 Coding for Proptosis(H05.241, H05.243)
Complete ICD-10-CM coding and documentation guide for Proptosis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Proptosis
H05.24Primary Range
Constant exophthalmos
This range includes specific codes for constant exophthalmos with laterality, which is essential for accurate documentation and coding of proptosis.
Thyrotoxicosis with diffuse goiter
This range is relevant when proptosis is secondary to thyroid eye disease, requiring the thyroid condition to be coded first.
Injury of eyeball and orbital tissues
This range is used when proptosis is due to trauma, with the injury code sequenced before the proptosis code.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H05.241 | Constant exophthalmos, right eye | Use when proptosis is documented specifically for the right eye with measurements. |
|
| H05.243 | Constant exophthalmos, bilateral | Use when proptosis is documented bilaterally with measurements. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for proptosis
Essential facts and insights about Proptosis
Primary ICD-10-CM Codes for proptosis
Decision Criteria
clinical Criteria
- Hertel measurement ≥22mm OD
documentation Criteria
- Documented laterality
Applicable To
- Proptosis of the right eye
Excludes
- Unspecified exophthalmos (H05.20)
Clinical Validation Requirements
- Hertel measurement ≥22mm OD
- Documentation of laterality
Code-Specific Risks
- Risk of using unspecified codes when laterality is known.
Coding Notes
- Ensure laterality is documented to avoid unspecified codes.
H05.243 - Constant exophthalmos, bilateral
Use when proptosis is documented bilaterally with measurements.
Applicable To
- Proptosis of both eyes
Excludes
- Unspecified exophthalmos (H05.20)
Clinical Validation Requirements
- Hertel measurement showing ≥2mm asymmetry from baseline or >21mm in both eyes
Coding Notes
Ensure bilateral involvement is documented to avoid unspecified codes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Thyrotoxicosis with diffuse goiter without thyrotoxic crisis
E05.00Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Unspecified exophthalmos
H05.20Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Proptosis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H05.241.
Impact
Clinical: Inaccurate clinical records., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always document laterality in clinical notes., Use templates that prompt for laterality.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Increases risk of audit failures., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Ensure laterality is documented and use specific codes like H05.241 or H05.242.
Impact
Unspecified codes increase audit risk.
Mitigation Strategy
Ensure documentation supports specific coding.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Proptosis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Proptosis
Use these documentation templates to ensure complete and accurate documentation for Proptosis. These templates include all required elements for proper coding and billing.
Bilateral proptosis with thyroid eye disease
Specialty: OphthalmologyRequired Elements
- Laterality
- Hertel measurement
- Thyroid function tests
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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