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ICD-10 Guide
ICD-10 CodesH11.052

H11.052

Billable

Peripheral pterygium, progressive, left eye

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

Code Description

ICD-10 H11.052 is a billable code used to indicate a diagnosis of peripheral pterygium, progressive, left eye.

Key Diagnostic Point:

Peripheral pterygium is a benign growth of conjunctival tissue that extends onto the cornea, typically originating from the limbus. In the case of a progressive pterygium in the left eye, the growth may invade deeper layers of the cornea and potentially affect vision. Clinically, patients may present with symptoms such as irritation, redness, and visual disturbances, particularly if the pterygium encroaches on the visual axis. The anatomy involved includes the conjunctiva, sclera, and cornea, with the anterior segment being the primary area of concern. Disease progression can lead to astigmatism and other refractive errors due to corneal distortion. Diagnostic considerations include a thorough ocular examination, slit-lamp biomicroscopy, and possibly imaging studies to assess the extent of the pterygium. Management may involve observation for asymptomatic cases, topical medications for inflammation, or surgical excision for progressive cases that threaten vision or cause significant discomfort.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a detailed ocular examination and understanding of corneal anatomy.
  • Treatment complexity: May involve both medical management and surgical intervention.
  • Documentation requirements: Requires thorough documentation of symptoms, examination findings, and treatment plans.
  • Coding specificity: Specific to progressive pterygium in the left eye, necessitating accurate coding.

Audit Risk Factors

  • Common coding errors: Misidentifying the eye involved or confusing with other conjunctival disorders.
  • Documentation gaps: Incomplete records of symptoms or treatment plans may lead to denials.
  • Billing challenges: Surgical procedures may require additional coding for associated services.

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 impact patients' quality of life, particularly if it progresses to affect vision. The condition is more prevalent in populations with high UV exposure, leading to increased healthcare utilization for surgical interventions. Understanding the epidemiology of pterygium can inform public health initiatives aimed at prevention and early intervention, ultimately improving patient outcomes and reducing healthcare costs.

ICD-9 vs ICD-10

Peripheral pterygium can significantly impact patients' quality of life, particularly if it progresses to affect vision. The condition is more prevalent in populations with high UV exposure, leading to increased healthcare utilization for surgical interventions. Understanding the epidemiology of pterygium can inform public health initiatives aimed at prevention and early intervention, ultimately improving patient outcomes and reducing healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the case and the procedures performed. Common denials can occur if documentation does not clearly establish the necessity for surgical intervention or if the diagnosis is not well-supported. Adhering to coding best practices, including using the correct modifiers for surgical procedures, can help mitigate billing challenges.

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 H11.052?

H11.052 specifically covers progressive peripheral pterygium in the left eye, characterized by conjunctival growth extending onto the cornea, which may lead to visual impairment.

When should H11.052 be used instead of related codes?

H11.052 should be used when documenting a progressive pterygium in the left eye, particularly when there are symptoms or visual disturbances. It is distinct from H11.051 (right eye) and H11.059 (unspecified eye).

What documentation supports H11.052?

Documentation should include a detailed ocular examination report, patient symptoms, treatment history, and any imaging studies performed to assess the pterygium's progression.