Crystal's MCW Coder Hub👁️ ICD-10-CM H02.052 — Trichiasis Without Entropion, Right Lower Eyelid
Billable Code — No Warning Needed
ICD-10-CM H02.052 is a valid, billable, fully specified 6-character ICD-10-CM code for FY2026. All six characters are present and meaningful:
H02(other disorders of eyelid) +.05(trichiasis without entropion) +2(right lower eyelid). This code specifically designates misdirected lashes of the right lower eyelid with the lid margin itself in a normal anatomic position — a critical clinical and coding distinction.
Non-Billable Parent Codes
- ❌
H02.05— 5-character header — missing laterality and lid specificity- ❌
H02.0— 4-character header — missing all specificity- ❌
H02.053— right eye, unspecified eyelid — do not use when documentation clearly states lower lid Always submit H02.052 (all 6 characters) when the lower right eyelid is documented.
Lower Eyelid Trichiasis Has a Distinct Clinical Signature
Lower lid misdirected lashes characteristically abrade the inferior cornea — producing inferior punctate epithelial erosions (PEE), inferior superficial punctate keratitis (SPK), and inferior corneal staining on fluorescein exam. This is the opposite of upper lid trichiasis, which causes superior corneal damage. Document the corneal location of staining carefully — inferior corneal involvement supports H02.052 (lower lid source) over H02.051 (upper lid source) when the clinical picture is ambiguous.
🔍 Code Description
ICD-10-CM H02.052 classifies trichiasis of the right lower eyelid occurring without concurrent entropion — one or more lower eyelashes of the right eye are growing inward toward the cornea or conjunctival surface while the lower eyelid margin remains in its correct anatomical position. Each blink mechanically drags the misdirected lash(es) across the inferior corneal epithelium and bulbar conjunctiva, generating a cycle of epithelial microtrauma, inflammatory response, reflex tearing, and risk of secondary infection.
The lower eyelid is biomechanically distinct from the upper lid. The lower lid lacks the firm tarsal plate height and levator-equivalent retractor support of the upper lid, making lower eyelid lash misdirection more commonly associated with horizontal lid laxity, post-inflammatory cicatricial scarring (e.g., from trachoma, Stevens-Johnson syndrome, or ocular cicatricial pemphigoid), and prior eyelid surgery than upper lid trichiasis. This etiologic distinction matters for documentation and for anticipating recurrence rates after treatment.
🌳 Code Tree / Hierarchy
H02.0 Entropion and trichiasis of eyelid ❌ Non-billable header
│
└── H02.05 Trichiasis without entropion ❌ Non-billable header
│
├── H02.051 Right upper eyelid ✅ Billable
├── H02.052 Right lower eyelid ◀ THIS CODE ✅
├── H02.053 Right eye, unspecified eyelid ✅ (use only if lid not documented)
├── H02.054 Left upper eyelid ✅ Billable
├── H02.055 Left lower eyelid ✅ Billable
├── H02.056 Left eye, unspecified eyelid ✅ (use only if lid not documented)
└── H02.059 Unspecified eye, unspecified eyelid ⚠️ Last resort only
H02.052 vs. Adjacent Laterality and Lid Codes
| Code | Eye | Lid | Clinical Use | Billable? |
|---|---|---|---|---|
| H02.051 | Right | Upper | Upper lash abrades superior cornea | ✅ |
| H02.052 | Right | Lower | Lower lash abrades inferior cornea ← This Code | ✅ |
| H02.053 | Right | Unspecified | Only if documentation omits upper vs. lower | ✅ |
| H02.054 | Left | Upper | Mirror of H02.051, left eye | ✅ |
| H02.055 | Left | Lower | Mirror of this code, left eye | ✅ |
| H02.056 | Left | Unspecified | Only if documentation omits upper vs. lower | ✅ |
| H02.059 | Unspecified | Unspecified | Documentation deficiency — query first | ✅ ⚠️ |
When Both Upper and Lower Right Eyelids Are Affected — Two Codes
If documentation states trichiasis of both the right upper and right lower eyelids, assign both H02.051 and H02.052 together. There is no bilateral-lid combination code — each eyelid gets its own code. This is one of the most under-coded scenarios in trichiasis: coders often assign only one code when the physician’s exam note describes misdirected lashes on multiple lids.
📋 Clinical Overview
Lower Eyelid Anatomy — Why It Matters for Coding
The lower eyelid contains the inferior tarsal plate (thinner and shorter than the superior tarsus), the lower lid retractors (capsulopalpebral fascia and inferior tarsal muscle), and the inferior punctum at the medial lid margin — the drainage entry point for tears. Understanding this anatomy helps you recognize documentation patterns:
| Anatomic Feature | Clinical Significance for H02.052 |
|---|---|
| Inferior tarsal plate | Thin — less structural support; cicatricial scarring here → lash misdirection |
| Capsulopalpebral fascia | Lower lid retractors — laxity → predisposes to ectropion AND trichiasis |
| Inferior cornea | Zona of contact — look for inferior SPK/PEE on exam documentation |
| Inferior punctum | Epiphora may be compounded by punctal malposition in same lower lid |
| Gray line | Landmark separating anterior and posterior lamellae — lid-splitting surgery targets this |
Symptoms — Right Lower Eyelid Trichiasis
| Symptom | Mechanism | Documentation Clue |
|---|---|---|
| Foreign body sensation | Lash tip dragging across cornea/conjunctiva with every blink | ”Feels like something in my eye” |
| Epiphora (tearing) | Reflex lacrimation from corneal epithelial irritation | ”Tearing right eye” |
| Photophobia | Corneal epithelial disruption lowers pain threshold to light | ”Light sensitivity right eye” |
| Inferior conjunctival injection | Mechanical irritation from lash contact with inferior bulbar conjunctiva | ”Redness right eye, inferior” |
| Inferior corneal staining | Punctate epithelial erosions at inferior 1/3 cornea | ”SPK inferior 1/3 OD” on slit lamp |
| Corneal abrasion | Prolonged or acute lash contact → epithelial defect | ”Corneal abrasion OD” — separately codeable |
| Reflex blepharospasm | Orbicularis spasm from pain/irritation | ”Twitching around right eye” |
| Chronic mucous discharge | Goblet cell irritation → mucinous tearing | ”Mucous discharge right eye” |
Common Etiologies for Lower Eyelid Trichiasis
Lower eyelid trichiasis has a broader and often more pathological etiology spectrum than upper lid:
| Etiology | Notes | Documentation Flag |
|---|---|---|
| Idiopathic / involutional | Isolated follicle misdirection — older adults | ”Misdirected lash, no etiology identified” |
| Blepharitis | Chronic lid margin inflammation → scarring of follicle root | ”Chronic blepharitis,” “lid margin disease” |
| Cicatricial conjunctivitis | Ocular cicatricial pemphigoid (OCP), Stevens-Johnson — subconjunctival fibrosis pulls lashes inward | ”OCP,” “SJS sequelae,” “conjunctival scarring” |
| Trachoma | Chlamydia trachomatis — leading infectious cause of trichiasis globally; progressive cicatricial disease | ”Trachoma” → code A71.x alongside H02.052 |
| Post-traumatic | Eyelid laceration scar, chemical burn, thermal burn | ”Post-traumatic,” “scar from prior injury” |
| Post-surgical | Prior lower lid surgery (blepharoplasty, ectropion repair, entropion repair) — suture scarring misdirects follicles | ”Post-blepharoplasty trichiasis” |
| Horizontal lid laxity | Redundant lower lid tissue — age-related; creates conditions for lash misdirection | Documented as “lower lid laxity” or on snap-back test |
| Epiblepharon | Congenital — Excludes1 applies (Q10.3x — not H02.052) | “Epiblepharon” → Q10.3 family only |
Trachoma-Related Trichiasis — Dual Coding Required
When trichiasis is documented as secondary to trachoma, you must code both the trachoma (A71.0 — initial stage, A71.1 — active stage, A71.9 — unspecified) and H02.052 for the trichiasis manifestation. Trachoma is among the most common causes of preventable blindness worldwide — if it appears in your documentation, every sequela must be captured.
Trichiasis vs. Ectropion vs. Entropion — The Lower Eyelid Triad
The lower eyelid is where all three conditions — trichiasis, ectropion, and entropion — can look similar on casual documentation review. Here is your coding triage reference:
| Condition | Lid Margin Position | Lash Direction | Key Documentation Words | Code |
|---|---|---|---|---|
| Trichiasis w/o entropion | Normal | Inward | ”misdirected lash,” “lash touching cornea,” “ingrowing lash” | H02.052 |
| Entropion | Inverted inward | All inward (lid dragged) | “lid turning in,” “entropion,” “lid inversion” | H02.002 / H02.012 / H02.022 / H02.032 |
| Ectropion | Everted outward | Outward (lid dragged away) | “lid turning out,” “ectropion,” “lower lid sagging” | H02.102-H02.106 |
| Trichiasis WITH entropion | Inverted | Inward (both) | “entropion with lashes abrading cornea” | Entropion code only — NOT H02.052 |
Entropion + Trichiasis ≠ H02.052
When entropion is the cause of lash misdirection, code the entropion (H02.0xx). H02.052 is reserved exclusively for trichiasis where the lid margin is confirmed to be in a normal position. If the physician notes both an inverted lid and misdirected lashes, the entropion is the primary condition driving the lash misdirection — do not assign H02.052 alongside an entropion code for the same eye unless they are genuinely independent findings.
🔬 Diagnostic Documentation — What to Look for in the Chart
Slit Lamp Exam Findings That Support H02.052
| Finding | Significance |
|---|---|
| Normal lid margin position | Confirms “without entropion” qualifier — must be documented or inferable |
| One or more lashes touching cornea/conjunctiva | Core finding — often stated as “lash on cornea OD” |
| Inferior SPK or PEE on fluorescein staining | Corneal evidence of lower lid lash contact — inferiorly located |
| Normal snap-back test | Lower lid snaps back quickly → rules out significant horizontal laxity/ectropion |
| Conjunctival injection inferior bulbar | Mechanical irritation distribution matches lower lid source |
| Absence of lid inversion on downgaze | Rules out intermittent entropion — important for the “without entropion” qualifier |
"Lash Touching Cornea" Is Your Documentation Gold
The most unambiguous documentation for H02.052 is a phrase like: “Right lower eyelid — one misdirected lash observed touching inferior cornea on slit lamp — lid margin in normal position.” If you see this in the attending note, H&P, or ophthalmology consult, H02.052 is your code. If the note just says “trichiasis right eye” without lid specification, query before defaulting to H02.053 (unspecified lid).
🛠️ CPT / HCPCS — Treatment Procedures for H02.052
Epilation Codes — The Primary Treatment
| CPT | Description | Modifier(s) | When to Use |
|---|---|---|---|
| 67820 | Correction of trichiasis; epilation by forceps only | -RT (right eye); -E4 (right lower lid — per-lid payers) | Mechanical forceps removal of misdirected lash(es) — most common first-line office procedure |
| 67825 | Correction of trichiasis; epilation by other than forceps (electrosurgery, cryotherapy, argon/diode laser, radiofrequency) | -RT (right eye); -E4 (right lower lid — per-lid payers) | When ablation or destruction of the lash follicle is performed to reduce recurrence |
Three Billing Methodologies — Know Your Payer's Rules
Per AAPC guidance, payers use one of three methods to reimburse epilation, and you must match your claim to your payer’s method:
Payer Method How to Bill Modifiers Per eye One unit of 67820 or 67825 per eye -RT (right) / -LT (left) / -50 (bilateral same session) Per eyelid One unit per eyelid treated -E4 (right lower), -E3 (right upper), -E1 (upper left), -E2 (lower left) Per lash One unit per lash removed Report per lash — rarely used; verify with payer before billing this way When multiple eyelids on the same eye are treated same session (e.g., H02.051 and H02.052 — both right upper and right lower), apply modifier -51 (multiple procedures) to the second code line for payers using per-lid billing.
When Both Upper and Lower Right Lids Are Treated Same Visit
| Line | CPT | Modifier | Diagnosis |
|---|---|---|---|
| 1 | 67820 | -RT or -E3 | H02.051 (right upper) |
| 2 | 67820 | -51 -E4 (or -RT) | H02.052 (right lower) |
Evaluation and Management — Trichiasis Visit Codes
| CPT | Description | When to Use |
|---|---|---|
| 92004 | Comprehensive ophthalmologic exam — new patient | New patient presenting with right lower eyelid trichiasis |
| 92014 | Comprehensive ophthalmologic exam — established patient | Follow-up trichiasis management visit |
| 92012 | Intermediate ophthalmologic exam — established patient | Brief check of lash status only; less comprehensive visit |
Epilation + Exam — Both Billable Same Day
An E/M or eye exam code (92012, 92014) and an epilation procedure code (67820, 67825) are billable on the same date of service. The epilation is a separately identifiable procedure from the diagnostic evaluation. No modifier -25 is required on ophthalmologic exam codes (unlike office-based E/M codes), but verify your payer’s rules — some commercial payers may require it anyway.
💊 Coding Scenarios
Scenario 1 — Routine Epilation by Forceps, Right Lower Eyelid (Outpatient)
Clinical Vignette: A 71-year-old male, established patient, presents for follow-up of known trichiasis. Slit lamp: one misdirected lash, right lower eyelid, intermittently contacting inferior cornea — inferior SPK grade 1 OD noted on fluorescein. Lower lid margin in normal position. Physician performs forceps epilation of one lash, right lower eyelid. Patient reports immediate symptom relief.
CPT / HCPCS:
- 92014 — Comprehensive ophthalmologic exam, established patient
- 67820-RT (or -E4 per-lid payers) — Epilation by forceps, right lower eyelid
ICD-10-CM:
- H02.052 — Trichiasis without entropion, right lower eyelid
Scenario 2 — Laser Epilation Right Lower Eyelid + Concurrent Corneal Abrasion (Outpatient)
Clinical Vignette: A 65-year-old female presents with acute pain, tearing, and photophobia right eye × 1 day. Slit lamp: three misdirected lashes right lower eyelid — one creating a 2mm linear inferior corneal abrasion confirmed with fluorescein. Lid margin normally positioned. No entropion. Physician performs argon laser epilation of three lashes, right lower eyelid, under topical anesthesia.
CPT / HCPCS:
- 92014 — Comprehensive ophthalmologic exam, established patient
- 67825-RT (or -E4) — Epilation by laser, right lower eyelid
ICD-10-CM:
- H02.052 — Trichiasis without entropion, right lower eyelid (primary — etiology of abrasion)
- H16.011 — Corneal abrasion, right eye (separately documented and codeable — acute epithelial defect)
Code the Corneal Abrasion Separately — It's a Real Comorbidity Here
When a misdirected lash creates a documented corneal abrasion (H16.011), code it in addition to H02.052. The trichiasis is the cause; the corneal abrasion is the acute sequela — both are documentable conditions affecting care at that encounter. Do not absorb the corneal abrasion into H02.052 — they are separate, billable diagnoses with separate clinical implications (the abrasion drives additional treatment: antibiotic drops, lubrication, possible patching).
Scenario 3 — Right Lower and Right Upper Lid Trichiasis — Two Codes Required (Outpatient)
Clinical Vignette: A 78-year-old female with chronic blepharitis. Slit lamp: multiple misdirected lashes both upper and lower right eyelid lids, all contacting corneal surface — superior and inferior SPK noted OD. Both lid margins normal position. Physician performs epilation by electrolysis of both right upper and right lower eyelid lashes.
CPT / HCPCS:
- 67825-E3 — Epilation by electrosurgery, right upper eyelid
- 67825-51-E4 — Epilation by electrosurgery, right lower eyelid (multiple procedure, same session)
- 92014 — Comprehensive ophthalmologic exam, established patient
ICD-10-CM:
- H02.051 — Trichiasis without entropion, right upper eyelid (both lids documented — both coded)
- H02.052 — Trichiasis without entropion, right lower eyelid
Scenario 4 — Bilateral Trichiasis — All Four Lids Affected (Outpatient)
Clinical Vignette: A 58-year-old male with history of Stevens-Johnson syndrome presents with recurrent bilateral trichiasis. Slit lamp: misdirected lashes present on all four eyelids — upper and lower right and left — all with corneal contact. No entropion on lid margin exam. Epilation by forceps performed on all four eyelids same session.
CPT / HCPCS:
- 67820-E3 — Epilation by forceps, right upper lid
- 67820-51-E4 — Epilation by forceps, right lower lid
- 67820-51-E1 — Epilation by forceps, left upper lid
- 67820-51-E2 — Epilation by forceps, left lower lid
- 92014 — Comprehensive ophthalmologic exam
ICD-10-CM:
- H02.051 — Trichiasis without entropion, right upper eyelid
- H02.052 — Trichiasis without entropion, right lower eyelid
- H02.054 — Trichiasis without entropion, left upper eyelid
- H02.055 — Trichiasis without entropion, left lower eyelid
Four Codes for Four Lids — This Is Correct
There is no single code for “trichiasis, all four eyelids.” Each affected eyelid requires its own specific code. This is one of the highest-value coding completeness opportunities in eyelid disorder coding — most coders only assign one or two codes when all four lids are documented. Capture every affected lid, especially in cicatricial disease patients (SJS, OCP, trachoma) who are high-frequency patients with complex documentation.
Scenario 5 — Trichiasis as Additional Diagnosis, Inpatient Admission
Clinical Vignette: A 69-year-old female admitted for elective lower blepharoplasty for dermatochalasis, right lower eyelid. H&P also documents: “Trichiasis right lower eyelid — managed with periodic office epilation — no surgical intervention for trichiasis planned this admission.” Condition is active, documented, and being managed.
Principal Diagnosis:
- H02.831 — Dermatochalasis of right upper eyelid (confirm with documentation — example only; use appropriate dermatochalasis code per documentation)
Additional Diagnoses:
- H02.052 — Trichiasis without entropion, right lower eyelid (documented active condition being managed — meets UHDDS criteria for additional diagnosis)
UHDDS Application — Trichiasis in the Inpatient Setting
As your CIC brain knows, a condition qualifies as a reportable additional diagnosis under UHDDS if it affects patient care through clinical evaluation, treatment, extended LOS, diagnostic procedures, or increased nursing/monitoring during the admission. Trichiasis actively managed outside the hospital (periodic epilation) and documented in the H&P qualifies — the physician is monitoring and managing it. It’s your professional judgment call as the coder whether the documentation is sufficient to support inclusion. When in doubt, query.
⚠️ Coding Pitfalls and Tips
| Pitfall or Tip | |
|---|---|
| ❌ | Never assign H02.052 when entropion is present — if the lid margin is inverted, use the appropriate entropion code (H02.002 / H02.012 / H02.022 / H02.032 for the right lower lid) |
| ❌ | Never default to H02.053 (unspecified lid) when documentation clearly states lower eyelid — code to the highest level of specificity always |
| ❌ | Never omit -RT or the appropriate E-modifier on 67820/67825 — modifier is required for laterality and per-lid adjudication |
| ❌ | Never assign H02.052 for epiblepharon or congenital lash misdirection — Excludes1 at H02 blocks use with Q10.0-Q10.3; use Q10.3x family |
| ❌ | Never code just one lid when documentation describes trichiasis on multiple lids — each affected lid gets its own code |
| ✅ | Check for concurrent corneal abrasion — H16.011 (right eye) is separately codeable when a misdirected lash creates a documented epithelial defect |
| ✅ | Check for concurrent dry eye — lower lid trichiasis and dry eye syndrome (H04.121 right eye) frequently co-exist; code both when documented |
| ✅ | Know your payer’s billing method — per eye, per lid, or per lash — before finalizing modifier strategy on 67820/67825 |
| ✅ | The treatment CPT is your fastest clue — if the physician bills 67820 or 67825, you are in the H02.05x code family |
| ✅ | For cicatricial trichiasis (SJS, OCP, trachoma) — consider whether an etiology code should accompany H02.052 per documentation |
| ✅ | Dynamic diagnosis — lower eyelid trichiasis is chronic and recurs after epilation; the patient will carry H02.052 across many encounters; confirm lash status is documented at each visit |
🔗 Related ICD-10-CM Codes
H02.05x — Complete Trichiasis Without Entropion Family
| Code | Description | Billable? |
|---|---|---|
| H02.05 | Trichiasis without entropion (header) | ❌ Non-billable |
| H02.051 | Right upper eyelid | ✅ |
| H02.052 | Right lower eyelid ← This Code | ✅ |
| H02.053 | Right eye, unspecified eyelid | ✅ (only if lid not documented) |
| H02.054 | Left upper eyelid | ✅ |
| H02.055 | Left lower eyelid | ✅ |
| H02.056 | Left eye, unspecified eyelid | ✅ (only if lid not documented) |
| H02.059 | Unspecified eye, unspecified eyelid ⚠️ | ✅ (last resort) |
Right Lower Eyelid Disorders — Differential Coding Reference
| Code | Description | When to Use |
|---|---|---|
| H02.052 | Trichiasis w/o entropion, right lower | ← This code — normal lid margin, misdirected lashes |
| H02.002 | Unspecified entropion, right lower eyelid | Lid margin turns inward — unspecified type |
| H02.012 | Cicatricial entropion, right lower eyelid | Lid inversion from scarring |
| H02.022 | Mechanical entropion, right lower eyelid | Lid inversion from external mechanical cause |
| H02.032 | Senile entropion, right lower eyelid | Age-related lid inversion |
| H02.102 | Unspecified ectropion, right lower eyelid | Lid margin turns outward |
| H02.112 | Cicatricial ectropion, right lower eyelid | Outward lid eversion from scarring |
| H02.122 | Mechanical ectropion, right lower eyelid | Outward lid eversion from mechanical cause |
| H02.132 | Senile ectropion, right lower eyelid | Age-related lid eversion |
Concurrent / Comorbid Codes — Co-Code When Documented
| Code | Description | Co-Code When |
|---|---|---|
| H16.011 | Corneal abrasion, right eye | Documented epithelial defect caused by misdirected lash |
| H16.141 | Punctate keratitis, right eye | Inferior SPK documented on fluorescein exam |
| H04.121 | Dry eye syndrome, right lacrimal gland | Co-existing dry eye documented |
| H10.811 | Conjunctivitis, right eye (other) | Documented conjunctival inflammation from lash irritation |
| H02.051 | Trichiasis w/o entropion, right upper eyelid | Upper lid also affected same eye |
| H02.054 | Trichiasis w/o entropion, left upper eyelid | Bilateral/multilid trichiasis |
| H02.055 | Trichiasis w/o entropion, left lower eyelid | Left lower lid also affected |
| A71.9 | Trachoma, unspecified | Trachoma documented as etiology |
📚 Sources
1. AAPC Codify. “ICD-10 Code H02.052 — Trichiasis without entropion, right lower eyelid.” Valid and billable FY2026.
2. AAPC Codify. “ICD-10 Code H02.05 — Trichiasis without entropion.” Full subcategory listing H02.051-H02.059; Excludes1 note at H02 for Q10.0-Q10.3.
3. Unbound Medicine ICD-10-CM. “H02.052 — Trichiasis without entropion right lower eyelid.” Billable code confirmed.
4. NIH VSAC / NLM. “H02.052 — ICD-10-CM 2023.” Code descriptor and system classification confirmed.
5. AAPC Ophthalmology Coding Alert. “Code Epilation for Trichiasis.” CPT 67820 and 67825 modifier strategy — per eye, per lid, per lash billing methodologies; -50/-RT/-LT/-E1-E4 guidance; modifier -51 for multiple lid same session.
6. MD Clarity. “CPT Code 67820: What It Is, Modifiers, Reimbursement.” Medical necessity documentation; Medicare coverage criteria for epilation.
7. PMC / Journal of Ophthalmology. “Management of trichiasis with lid margin split and cryotherapy.” Cryotherapy outcomes for lower lid trichiasis; 90% success rate; recurrence data.
8. EyeWiki AAO. “Trichiasis.” Electrolysis, laser ablation, cryotherapy clinical indications; lower eyelid treatment algorithm.
9. Ophthalmology Management. “Coding & Reimbursement — CPT 67820/67825.” Epilation code descriptions and payer reimbursement guidance.