ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesH11.04

H11.04

Non-billable

Peripheral pterygium of eye, stationary

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

Code Description

ICD-10 H11.04 is a used to indicate a diagnosis of peripheral pterygium of eye, stationary.

Key Diagnostic Point:

Peripheral pterygium of the eye, stationary, is characterized by a triangular-shaped growth of conjunctival tissue that extends onto the cornea. This condition typically arises due to chronic irritation, often from environmental factors such as UV light exposure, dust, or wind. The anatomy involved includes the conjunctiva, sclera, and cornea, with the pterygium primarily affecting the conjunctival surface and potentially encroaching on the corneal tissue. Clinically, patients may present with symptoms such as redness, irritation, and a foreign body sensation, although many remain asymptomatic. Disease progression can vary; while some pterygia remain stationary, others may grow and cause visual disturbances or astigmatism. Diagnostic considerations include a thorough ocular examination, where the growth's appearance, location, and any associated symptoms are assessed. Additionally, differential diagnoses may include other conjunctival lesions, making accurate identification crucial for appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as differentiation from other conjunctival lesions is necessary.
  • Treatment complexity: Low to medium, depending on whether surgical intervention is required.
  • Documentation requirements: Moderate, necessitating detailed clinical notes and examination findings.
  • Coding specificity: Medium, as it requires precise identification of the condition.

Audit Risk Factors

  • Common coding errors: Misclassification with active pterygium codes.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and examination findings.
  • Billing challenges: Potential denials if the necessity for treatment 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

Primary care

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

Peripheral pterygium, while often benign, can significantly affect patient quality of life due to discomfort and potential visual impairment. The condition is prevalent in populations exposed to high levels of UV light, such as outdoor workers. Understanding its epidemiology is crucial for preventive measures and public health initiatives aimed at reducing risk factors. Quality measures may include monitoring the incidence of pterygium and ensuring appropriate management to prevent progression.

ICD-9 vs ICD-10

Peripheral pterygium, while often benign, can significantly affect patient quality of life due to discomfort and potential visual impairment. The condition is prevalent in populations exposed to high levels of UV light, such as outdoor workers. Understanding its epidemiology is crucial for preventive measures and public health initiatives aimed at reducing risk factors. Quality measures may include monitoring the incidence of pterygium and ensuring appropriate management to prevent progression.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of surgical intervention if the pterygium causes significant symptoms or visual impairment. Common denials may occur if the documentation does not clearly establish the stationary nature of the pterygium or if the treatment is deemed not medically necessary. Best practices include ensuring that all clinical findings are well-documented and that the rationale for any procedures performed is clearly articulated.

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 H11.04?

H11.04 specifically covers stationary peripheral pterygium, which is a benign growth of conjunctival tissue that does not exhibit signs of inflammation or active growth.

When should H11.04 be used instead of related codes?

H11.04 should be used when the pterygium is confirmed to be stationary and not causing significant symptoms or visual impairment, differentiating it from active or recurrent pterygium codes.

What documentation supports H11.04?

Documentation should include a detailed ocular examination report, noting the size, location, and characteristics of the pterygium, as well as any symptoms reported by the patient.