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ICD-10 Guide
ICD-10 CodesH11.1

H11.1

Non-billable

Conjunctival degenerations and deposits

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

Code Description

ICD-10 H11.1 is a used to indicate a diagnosis of conjunctival degenerations and deposits.

Key Diagnostic Point:

H11.1 refers to conjunctival degenerations and deposits, which encompass a range of conditions affecting the conjunctiva, the thin membrane covering the white part of the eye and the inner surface of the eyelids. Common clinical presentations include pingueculae and pterygia, which are characterized by yellowish, raised lesions on the conjunctiva due to UV exposure, chronic irritation, or aging. These degenerative changes can lead to discomfort, redness, and visual disturbances if they encroach upon the cornea. The anatomy involved primarily includes the conjunctiva, sclera, and adjacent structures of the anterior segment of the eye. Disease progression may vary; while some cases remain stable, others can progress to more significant visual impairment or require surgical intervention. Diagnostic considerations include a thorough ocular examination, patient history, and possibly imaging studies to assess the extent of degeneration and rule out other pathologies. Early identification and management are crucial to prevent complications and maintain ocular health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of H11.1 lies in its potential to affect visual acuity and patient quality of life. Conjunctival degenerations can lead to discomfort and may necessitate surgical intervention if they progress. Population health impact includes the need for increased awareness of UV protection and regular eye examinations, especially in at-risk populations. Quality measures may focus on timely diagnosis and management of these conditions to prevent complications, while healthcare utilization patterns reflect the importance of ophthalmic care in maintaining ocular health.

ICD-9 vs ICD-10

The clinical significance of H11.1 lies in its potential to affect visual acuity and patient quality of life. Conjunctival degenerations can lead to discomfort and may necessitate surgical intervention if they progress. Population health impact includes the need for increased awareness of UV protection and regular eye examinations, especially in at-risk populations. Quality measures may focus on timely diagnosis and management of these conditions to prevent complications, while healthcare utilization patterns reflect the importance of ophthalmic care in maintaining ocular health.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for ophthalmology services and ensuring that the services rendered are medically necessary. Common denials may arise from insufficient documentation or failure to demonstrate the necessity of the procedure. Best practices include thorough documentation of the clinical findings, patient symptoms, and any treatments provided, as well as regular updates to coding practices to reflect the latest guidelines.

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 H11.1?

H11.1 covers conditions such as pingueculae, pterygia, and other conjunctival degenerative changes. These conditions are characterized by the presence of deposits or growths on the conjunctiva, often related to environmental factors or aging.

When should H11.1 be used instead of related codes?

H11.1 should be used when the primary diagnosis involves degenerative changes of the conjunctiva without significant inflammatory or neoplastic components. If the condition is primarily inflammatory or involves other structures, different codes may be more appropriate.

What documentation supports H11.1?

Documentation should include a detailed ocular examination report, patient history indicating symptoms and duration, and any imaging studies performed. Clear descriptions of the conjunctival findings and their impact on the patient's vision are essential.