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ICD-10 Guide
ICD-10 CodesH11.12

H11.12

Non-billable

Conjunctival concretions

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

Code Description

ICD-10 H11.12 is a used to indicate a diagnosis of conjunctival concretions.

Key Diagnostic Point:

Conjunctival concretions, also known as conjunctival cysts or concretions, are small, yellowish-white deposits that form within the conjunctiva, the thin membrane covering the white part of the eye and the inner surface of the eyelids. These deposits are composed of epithelial cells, mucus, and inflammatory debris. Clinically, patients may present with symptoms such as irritation, foreign body sensation, or mild redness, although many cases are asymptomatic. The condition is often benign and does not typically lead to serious complications. Anatomically, the conjunctiva is involved, but adjacent structures such as the sclera and cornea may also be affected indirectly through irritation. Disease progression is generally slow, and while conjunctival concretions can persist, they often require no treatment unless symptomatic. Diagnostic considerations include a thorough ocular examination, where the presence of concretions can be confirmed through visual inspection. In some cases, differential diagnoses may include conjunctival cysts or other conjunctival lesions, necessitating careful evaluation to ensure accurate diagnosis and management.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low - straightforward diagnosis through visual examination
  • Treatment complexity: Low - often requires no treatment; symptomatic cases may need simple removal
  • Documentation requirements: Low - minimal documentation needed for diagnosis and treatment
  • Coding specificity: Medium - specific to conjunctival concretions but may overlap with other conjunctival conditions

Audit Risk Factors

  • Common coding errors: Misclassification with other conjunctival disorders
  • Documentation gaps: Lack of detailed clinical notes on symptoms and examination findings
  • Billing challenges: Potential for denials if documentation does not clearly support the diagnosis

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: 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

Conjunctival concretions, while generally benign, can impact patient quality of life due to discomfort or irritation. Understanding their prevalence and management is important for population health, as they are common in older adults. Effective management can reduce unnecessary healthcare visits and improve patient satisfaction. Quality measures may include tracking the incidence of symptomatic cases and ensuring appropriate follow-up care.

ICD-9 vs ICD-10

Conjunctival concretions, while generally benign, can impact patient quality of life due to discomfort or irritation. Understanding their prevalence and management is important for population health, as they are common in older adults. Effective management can reduce unnecessary healthcare visits and improve patient satisfaction. Quality measures may include tracking the incidence of symptomatic cases and ensuring appropriate follow-up care.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, but typically, benign conditions like conjunctival concretions are less likely to face denials if well-documented. Common denials may arise from insufficient clinical evidence supporting the diagnosis or treatment. Best practices include ensuring that all relevant symptoms and examination findings are documented, and that the medical necessity for any procedures performed is clearly established.

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 H11.12?

H11.12 specifically covers conjunctival concretions, which are benign deposits within the conjunctiva. It does not include other conjunctival lesions such as cysts or tumors, which may require different codes.

When should H11.12 be used instead of related codes?

H11.12 should be used when the diagnosis is specifically conjunctival concretions, particularly when the patient presents with symptoms related to these deposits. If the condition involves other conjunctival issues, different codes may be more appropriate.

What documentation supports H11.12?

Documentation should include a detailed ocular examination report, noting the presence of concretions, any associated symptoms, and the clinical decision regarding treatment or observation. Photographic evidence may also support the diagnosis.