ICD Code H04.123

ICD code H04.123 is dry eye syndrome affecting both lacrimal glands (the glands in both eyes that produce tears).

1. Presence of persistent dryness, irritation, or discomfort in both eyes

2. Clinical evidence of decreased tear production or increased tear evaporation affecting both eyes

3. Objective findings such as reduced tear break-up time or abnormal Schirmer’s test results in both eyes

4. Absence of other ocular surface diseases or systemic conditions that could explain symptoms

5. Symptoms not attributable to medication side effects or environmental factors alone

6. Chronicity of symptoms, typically lasting for several weeks or longer

Relevant CPT codes that may be used to treat ICD code H04.123 include:

- 92002: Ophthalmological services; new patient, evaluation and management

- 92004: Comprehensive eye exam, new patient

- 92012: Ophthalmological services; established patient, evaluation and management

- 92014: Comprehensive eye exam, established patient

- 65205: Removal of foreign body from eye, external

- 68761: Closure of the lacrimal punctum by plug, each

- 67800: Excision of lesion of eyelid (except chalazion) up to 1 cm

- 99213, 99214: Office or other outpatient visit for the evaluation and management of an established patient

Selection of CPT codes should be based on the specific services rendered for H04.123.

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