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H21.02

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🧬 ICD-10 CM H21.02 - Hyphema, Left Eye

Clinical Context

Hyphema is the collection of blood in the anterior chamber of the eye (between the cornea and the iris).

  • Etiology: Most commonly blunt trauma (e.g., airbag, fist, ball), but can be spontaneous (neovascularization, clotting disorders).

  • Risks: High intraocular pressure (glaucoma), corneal staining, and re-bleeding.

Trauma Coding

If the hyphema is traumatic, you must also code the Injury (S-code) and External Cause (W/X/Y-code).

  • Example: S05.12XA (Contusion of eyeball and orbital tissues, left eye) + H21.02.

  • Note: Some payers prefer the S-code as primary for trauma, while H21.02 specifies the nature of the injury.

ICD-10-CM Diagnosis Codes

Primary Code

  • H21.02 - Hyphema, left eye

    • Usage: Specific for blood in the AC of the left eye.

  • H21.01 - Hyphema, right eye.

  • H21.03 - Hyphema, bilateral.

  • H21.00 - Hyphema, unspecified eye.

CPT Procedure Codes (Management)

1. Anterior Chamber Washout (Paracentesis)

Code: 65815

Long Title: Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without irrigation and/or air injection.

  • Explanation: Performed if IOP is uncontrollably high or to prevent corneal blood staining. The surgeon enters the AC and washes out the blood.

  • wRVU (approx): 3.50 - 4.00 (varies by setting)

  • Global Period: 000 (Zero days)

  • Assistant Payable: No

2. Evaluation & Management

Codes: 99202-99215 (E/M) or 92002-92014 (Eye Codes)

  • Explanation: Most hyphemas are managed medically (observation, cycloplegics, steroids) with daily pressure checks.

Bundling & NCCI Edits

Procedure vs. Exam

Exam on Day of Washout

  • If 65815 (Washout) is performed, the E/M visit on the same day is bundled unless a significant, separate service is documented (Modifier -25).

  • Since the Global Period is 000, follow-up visits the next day are fully billable.

Risk Adjustment (HCC)

  • HCC Category: None.

    • Note: Hyphema is an acute condition and does not map to a CMS-HCC risk category.

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