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ICD-10 Guide
ICD-10 CodesH11.022

H11.022

Billable

Central pterygium of left eye

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

Code Description

ICD-10 H11.022 is a billable code used to indicate a diagnosis of central pterygium of left eye.

Key Diagnostic Point:

Central pterygium of the left eye is a growth of conjunctival tissue that extends onto the cornea, typically originating from the nasal side. Clinically, it presents as a triangular, fleshy tissue that can cause visual disturbances, irritation, and discomfort. The anatomy involved includes the conjunctiva, cornea, and potentially the sclera if the pterygium progresses. Disease progression can lead to increased corneal astigmatism and visual impairment if left untreated. Diagnosis is primarily clinical, based on the appearance of the pterygium during a comprehensive eye examination. Additional diagnostic considerations may include slit-lamp examination to assess the extent of corneal involvement and potential impact on vision. In some cases, imaging may be utilized to evaluate the extent of the growth and its effect on surrounding structures. Early detection and management are crucial to prevent complications associated with significant corneal involvement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires clinical evaluation and differentiation from other conjunctival lesions.
  • Treatment complexity: Moderate, as treatment may involve surgical intervention if the pterygium is symptomatic or visually impairing.
  • Documentation requirements: Requires detailed documentation of clinical findings and treatment plans.
  • Coding specificity: Specific to central pterygium of the left eye, which aids in accurate coding.

Audit Risk Factors

  • Common coding errors: Misidentifying the eye involved or using a general code instead of the specific pterygium code.
  • Documentation gaps: Incomplete clinical notes regarding the extent of the pterygium and its symptoms.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis or treatment provided.

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

Central pterygium can significantly affect an individual's quality of life by causing discomfort and visual impairment. It is more prevalent in populations exposed to UV light and environmental irritants, making it a public health concern in certain demographics. Understanding the epidemiology of pterygium can aid in developing preventive measures and improving healthcare utilization patterns for affected individuals.

ICD-9 vs ICD-10

Central pterygium can significantly affect an individual's quality of life by causing discomfort and visual impairment. It is more prevalent in populations exposed to UV light and environmental irritants, making it a public health concern in certain demographics. Understanding the epidemiology of pterygium can aid in developing preventive measures and improving healthcare utilization patterns for affected individuals.

Reimbursement & Billing Impact

Reimbursement considerations include the need for prior authorization for surgical procedures, if applicable. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for treatment. Best practices include maintaining thorough clinical notes, ensuring that the diagnosis aligns with the procedure codes used, and verifying insurance requirements for pterygium treatment.

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 H11.022?

H11.022 specifically covers central pterygium of the left eye. It is characterized by a triangular growth of conjunctival tissue on the cornea, which may lead to irritation, astigmatism, and visual impairment.

When should H11.022 be used instead of related codes?

H11.022 should be used when documenting a central pterygium specifically affecting the left eye. It is important to differentiate it from right eye (H11.021) and bilateral (H11.023) pterygium codes based on clinical findings.

What documentation supports H11.022?

Documentation should include a detailed clinical examination report, including the size, location, and symptoms associated with the pterygium, as well as any visual acuity assessments and treatment plans.