Ophthalmology and Optometry Coding Alert

Question: The ophthalmologist diagnosed the patient with right upper eyelid edema due to allergies. What diagnosis code should I use to report this condition?

New Hampshire Subscriber

Answer: Right now, you’ll assign H01.8 (Other specified inflammations of eyelid) to report the eyelid edema due to allergies diagnosis. However, when ICD-10-CM takes effect on Oct. 1, 2025, you’ll be able to add more specificity to your coding.

In the 2026 ICD-10-CM code book, H01.8 will be converted to a parent code, and the following eyelid inflammation codes will be listed under it:

• H01.81 (Other specified inflammation of right upper eyelid)
• H01.82 (Other specified inflammation of right lower eyelid)
• H01.83 (Other specified inflammation of right eye, unspecified eyelid)
• H01.84 (Other specified inflammation of left upper eyelid)
• H01.85 (Other specified inflammation of left lower eyelid)
• H01.86 (Other specified inflammation of left eye, unspecified eyelid)
• H01.89 (Other specified inflammation of unspecified eye, unspecified eyelid)
• H01.8A (Other specified inflammation of right eye, upper and lower eyelids)
• H01.8B (Other specified inflammation of left eye, upper and lower eyelids)

As you can see, the 5^th characters help specify the eye laterality, and which eyelid is affected by the condition. In your case, you’d use H01.81 to report the right upper eyelid edema if the encounter took place on or after Oct. 1, 2025.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC