Chalazion left upper eyelid

This code signifies a chronic, sterile, lipogranulomatous inflammation of the meibomian gland located in the upper eyelid of the left eye. It presents as a firm, painless nodule resulting from obstruction of the gland's duct and subsequent extravasation of sebaceous secretions into the surrounding tissue.

Apply this code when documentation clearly indicates a chalazion affecting the left upper eyelid. This diagnosis is typically made based on clinical examination, noting the characteristic firm, non-tender lump. It is appropriate for both initial diagnosis and subsequent encounters related to this specific condition.

• Differentiate from a hordeolum (stye), which is an acute bacterial infection and coded differently.
• Ensure laterality (left) and eyelid (upper) are explicitly documented to support this specific code.
• If the chalazion affects multiple sites or is bilateral, select the appropriate combination or bilateral codes.