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ICD-10 Guide
ICD-10 CodesH11.013

H11.013

Billable

Amyloid pterygium of eye, bilateral

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

Code Description

ICD-10 H11.013 is a billable code used to indicate a diagnosis of amyloid pterygium of eye, bilateral.

Key Diagnostic Point:

Amyloid pterygium of the eye, bilateral, is characterized by the deposition of amyloid protein in the conjunctiva, leading to a yellowish-white, gelatinous appearance. This condition typically affects the conjunctiva but can also involve the sclera and cornea, potentially causing visual disturbances. The bilateral nature of this condition suggests systemic amyloidosis, which may be associated with underlying diseases such as multiple myeloma or chronic inflammatory conditions. Clinically, patients may present with irritation, discomfort, or cosmetic concerns. The disease progression can vary; while some patients remain asymptomatic, others may experience significant ocular surface issues. Diagnostic considerations include a thorough ocular examination, slit-lamp evaluation, and possibly a biopsy to confirm amyloid deposits. The presence of amyloid pterygium may necessitate further investigation for systemic conditions, emphasizing the importance of a comprehensive clinical assessment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other conjunctival lesions and systemic evaluation.
  • Treatment complexity: Management may involve surgical intervention, particularly if vision is affected.
  • Documentation requirements: Detailed clinical notes are essential to support diagnosis and treatment.
  • Coding specificity: Requires precise coding to reflect bilateral involvement and associated conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with other conjunctival disorders.
  • Documentation gaps: Incomplete clinical notes regarding systemic evaluation.
  • Billing challenges: Potential denials if the bilateral nature 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

Rheumatology

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

The clinical significance of H11.013 lies in its association with systemic amyloidosis, which can affect multiple organ systems. Understanding this condition is crucial for population health, as early detection and management can improve patient outcomes. Quality measures may include monitoring for visual impairment and the need for surgical interventions. Epidemiologically, the prevalence of amyloid pterygium may reflect underlying systemic diseases, highlighting the importance of comprehensive care in affected populations.

ICD-9 vs ICD-10

The clinical significance of H11.013 lies in its association with systemic amyloidosis, which can affect multiple organ systems. Understanding this condition is crucial for population health, as early detection and management can improve patient outcomes. Quality measures may include monitoring for visual impairment and the need for surgical interventions. Epidemiologically, the prevalence of amyloid pterygium may reflect underlying systemic diseases, highlighting the importance of comprehensive care in affected populations.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for diagnostic tests and potential surgical interventions. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Best practices include maintaining thorough clinical notes, ensuring accurate coding, and pre-authorization for surgical procedures when applicable.

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 H11.013?

H11.013 specifically covers bilateral amyloid pterygium, which is characterized by amyloid deposits in the conjunctiva. It is important to differentiate this from other conjunctival lesions such as pterygium or conjunctival cysts.

When should H11.013 be used instead of related codes?

H11.013 should be used when there is confirmed bilateral amyloid pterygium, especially when systemic evaluation for amyloidosis is warranted. It is distinct from unilateral cases or other conjunctival disorders.

What documentation supports H11.013?

Documentation should include a detailed ocular examination, findings from slit-lamp evaluation, and any biopsy results confirming amyloid deposits. Notes on systemic evaluation for underlying conditions are also crucial.