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ICD-10 Guide
ICD-10 CodesH11.062

H11.062

Billable

Recurrent pterygium of left eye

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

Code Description

ICD-10 H11.062 is a billable code used to indicate a diagnosis of recurrent pterygium of left eye.

Key Diagnostic Point:

Recurrent pterygium of the left eye is characterized by the growth of a fleshy, triangular tissue on the conjunctiva that extends onto the cornea. This condition typically arises after surgical excision of a primary pterygium, which is a benign growth often associated with UV exposure, dry environments, and chronic irritation. Clinically, patients may present with symptoms such as irritation, redness, and visual disturbances if the pterygium encroaches on the visual axis. The anatomy involved includes the conjunctiva, cornea, and potentially the sclera, as the pterygium can affect the underlying structures. Disease progression may lead to increased vascularization and inflammation, necessitating further surgical intervention. Diagnostic considerations include a thorough ocular examination, patient history, and possibly imaging studies to assess the extent of the growth and its impact on visual function. Regular monitoring is essential to manage recurrence effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other conjunctival lesions.
  • Treatment complexity: May involve surgical excision and management of recurrence.
  • Documentation requirements: Detailed clinical notes and follow-up assessments are necessary.
  • Coding specificity: Requires accurate coding to reflect the recurrent nature and specific eye involved.

Audit Risk Factors

  • Common coding errors: Misclassification of primary versus recurrent pterygium.
  • Documentation gaps: Incomplete records of prior surgeries or treatment responses.
  • Billing challenges: Denials may occur if the recurrent 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

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

Recurrent pterygium can significantly affect patients' quality of life due to discomfort and potential vision impairment. The condition is prevalent in populations exposed to high UV radiation, particularly in tropical regions. Understanding its epidemiology is crucial for preventive measures and public health initiatives aimed at reducing UV exposure. Effective management of recurrent pterygium can improve patient outcomes and reduce healthcare utilization associated with repeated surgeries.

ICD-9 vs ICD-10

Recurrent pterygium can significantly affect patients' quality of life due to discomfort and potential vision impairment. The condition is prevalent in populations exposed to high UV radiation, particularly in tropical regions. Understanding its epidemiology is crucial for preventive measures and public health initiatives aimed at reducing UV exposure. Effective management of recurrent pterygium can improve patient outcomes and reduce healthcare utilization associated with repeated surgeries.

Reimbursement & Billing Impact

Reimbursement considerations include the need for pre-authorization for surgical procedures, especially if the patient has a history of prior surgeries. Common denials may arise from insufficient documentation of recurrence or lack of detailed clinical notes. Best practices include maintaining thorough records of patient history, treatment plans, and follow-up assessments to support the medical necessity of the procedures performed.

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 H11.062?

H11.062 specifically covers recurrent pterygium of the left eye. It is important to differentiate it from primary pterygium (H11.061) and other conjunctival disorders that may present similarly.

When should H11.062 be used instead of related codes?

H11.062 should be used when there is a documented history of a previous pterygium excision and the patient presents with a recurrence of the growth on the left eye. Accurate documentation of the recurrence is essential for appropriate code selection.

What documentation supports H11.062?

Documentation should include a detailed history of the patient's previous pterygium, surgical interventions, current symptoms, and findings from the ocular examination. Follow-up notes indicating the recurrence and any treatment plans are also necessary.