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ICD-10 Guide
ICD-10 CodesH11.051

H11.051

Billable

Peripheral pterygium, progressive, right eye

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

Code Description

ICD-10 H11.051 is a billable code used to indicate a diagnosis of peripheral pterygium, progressive, right eye.

Key Diagnostic Point:

Peripheral pterygium, progressive, right eye is a condition characterized by the abnormal growth of conjunctival tissue onto the cornea, typically starting from the nasal or temporal side. This growth can lead to visual impairment as it encroaches upon the visual axis, potentially causing astigmatism and discomfort. The anatomy involved includes the conjunctiva, cornea, and sclera, with the pterygium affecting the anterior segment of the eye. Clinically, patients may present with symptoms such as redness, irritation, and a noticeable growth on the eye. Disease progression can vary, with some pterygia remaining stable while others may grow rapidly, necessitating surgical intervention. Diagnostic considerations include a thorough eye examination, slit-lamp evaluation, and possibly imaging studies to assess the extent of the growth and its impact on surrounding structures. Early diagnosis and management are crucial to prevent complications and preserve vision.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive eye examination and differential diagnosis to rule out other conditions.
  • Treatment complexity: Management may involve observation, topical medications, or surgical excision depending on severity.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate between types of pterygium and their progression.

Audit Risk Factors

  • Common coding errors: Misidentification of the eye involved or failure to document the progressive nature.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis or treatment.
  • Billing challenges: Potential denials if the medical necessity is not clearly established.

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

Peripheral pterygium can significantly affect quality of life by impairing vision and causing discomfort. Its prevalence varies by geographic location and environmental factors, such as UV exposure. Understanding the epidemiology of pterygium is crucial for public health initiatives aimed at prevention and early intervention. Effective management can reduce healthcare utilization and improve patient outcomes.

ICD-9 vs ICD-10

Peripheral pterygium can significantly affect quality of life by impairing vision and causing discomfort. Its prevalence varies by geographic location and environmental factors, such as UV exposure. Understanding the epidemiology of pterygium is crucial for public health initiatives aimed at prevention and early intervention. Effective management can reduce healthcare utilization and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement may vary based on the severity of the condition and the treatment provided. Common denials can occur if the documentation does not adequately support the diagnosis or if the procedure performed is not clearly linked to the diagnosis. Coders should ensure that all relevant details are included in the medical record to facilitate smooth billing processes.

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 H11.051?

H11.051 specifically covers progressive peripheral pterygium in the right eye, which is characterized by the growth of conjunctival tissue onto the cornea. It does not include other types of pterygium or related conjunctival disorders.

When should H11.051 be used instead of related codes?

H11.051 should be used when documenting a progressive pterygium specifically affecting the right eye. If the condition affects the left eye or is bilateral, the appropriate codes H11.052 or H11.053 should be utilized.

What documentation supports H11.051?

Documentation should include a detailed clinical examination report, patient symptoms, the extent of the pterygium, and any treatment plans. Photographic evidence may also be beneficial in supporting the diagnosis.