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ICD-10 Guide
ICD-10 CodesH11.069

H11.069

Billable

Recurrent pterygium of unspecified eye

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 H11.069 is a billable code used to indicate a diagnosis of recurrent pterygium of unspecified eye.

Key Diagnostic Point:

Recurrent pterygium of unspecified eye is characterized by the growth of a fleshy, triangular tissue on the conjunctiva that can invade the cornea. This condition often arises after surgical excision of a primary pterygium, leading to its recurrence. Clinically, patients may present with symptoms such as redness, irritation, and visual disturbances due to corneal involvement. The anatomy involved includes the conjunctiva, sclera, and cornea, with the anterior segment of the eye being significantly affected. Disease progression can lead to increased corneal astigmatism and potential vision loss if left untreated. Diagnostic considerations include a thorough ocular examination, assessment of visual acuity, and possibly imaging studies to evaluate the extent of the pterygium. The diagnosis is typically made based on clinical findings, and recurrence is often confirmed through patient history and examination findings.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of ocular anatomy and pathology.
  • Treatment complexity: May involve surgical intervention and postoperative care.
  • Documentation requirements: Detailed clinical notes and follow-up assessments are necessary.
  • Coding specificity: Requires accurate differentiation from other conjunctival and corneal disorders.

Audit Risk Factors

  • Common coding errors: Misclassification of pterygium type or eye involved.
  • Documentation gaps: Incomplete records of recurrence or treatment history.
  • Billing challenges: Potential denials if recurrence is not clearly documented.

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Optometry

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Recurrent pterygium can significantly affect patient quality of life, leading to discomfort and visual impairment. Its prevalence varies by geographic location and environmental factors, with higher rates in areas with increased UV exposure. Understanding the epidemiology of pterygium is crucial for population health initiatives aimed at prevention and management. Quality measures may include tracking surgical outcomes and recurrence rates, which can inform healthcare utilization patterns and resource allocation.

ICD-9 vs ICD-10

Recurrent pterygium can significantly affect patient quality of life, leading to discomfort and visual impairment. Its prevalence varies by geographic location and environmental factors, with higher rates in areas with increased UV exposure. Understanding the epidemiology of pterygium is crucial for population health initiatives aimed at prevention and management. Quality measures may include tracking surgical outcomes and recurrence rates, which can inform healthcare utilization patterns and resource allocation.

Reimbursement & Billing Impact

Reimbursement considerations include the need for pre-authorization for surgical procedures and ensuring that all documentation supports the medical necessity of the treatment. Common denials may arise from insufficient documentation of recurrence or failure to specify the eye involved. Best practices include thorough clinical notes and follow-up assessments to substantiate the diagnosis and treatment plan.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for H00-H99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for H00-H99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by H11.069?

H11.069 covers recurrent pterygium that has reappeared after previous treatment, specifically when the eye involved is unspecified. It does not include primary pterygium or other conjunctival disorders.

When should H11.069 be used instead of related codes?

H11.069 should be used when documenting a recurrent pterygium without specifying the eye, particularly when the patient has a history of pterygium excision and presents with symptoms of recurrence.

What documentation supports H11.069?

Documentation should include a detailed history of the patient's previous pterygium, clinical findings during examination, treatment history, and any symptoms indicating recurrence.