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ICD-10 Guide
ICD-10 CodesH11.121

H11.121

Billable

Conjunctival concretions, right eye

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

Code Description

ICD-10 H11.121 is a billable code used to indicate a diagnosis of conjunctival concretions, right eye.

Key Diagnostic Point:

Conjunctival concretions, also known as conjunctival cysts or concretions, are small, yellowish-white deposits that can form on the conjunctiva of the eye, particularly in the right eye as denoted by the code H11.121. These deposits are composed of epithelial cells, mucus, and other debris, and they can vary in size. Clinically, patients may present with symptoms such as irritation, foreign body sensation, or redness in the affected eye. The conjunctiva is a thin, transparent membrane that covers the white part of the eyeball and lines the inside of the eyelids, making it crucial for eye health and function. Disease progression is generally benign, but larger concretions can lead to discomfort and may require removal. Diagnostic considerations include a thorough ocular examination, where the clinician assesses the size, location, and number of concretions, often using a slit lamp for enhanced visualization. Differential diagnoses may include pingueculae or pterygia, which can present similarly but have different underlying causes and management strategies.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low - straightforward diagnosis with visual examination
  • Treatment complexity: Low - typically involves simple removal if symptomatic
  • Documentation requirements: Low - basic documentation of symptoms and findings
  • Coding specificity: Medium - specific to right eye, but limited in broader context

Audit Risk Factors

  • Common coding errors: Misidentifying the laterality or confusing with other conjunctival conditions
  • Documentation gaps: Incomplete patient history or lack of symptom description
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis

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

Primary Care

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 and irritation. Understanding the prevalence and management of this condition contributes to better population health outcomes, as timely diagnosis and treatment can prevent complications. Monitoring healthcare utilization patterns for conjunctival disorders can help identify trends and improve care strategies, ultimately enhancing patient satisfaction and quality measures in ophthalmic care.

ICD-9 vs ICD-10

Conjunctival concretions, while generally benign, can impact patient quality of life due to discomfort and irritation. Understanding the prevalence and management of this condition contributes to better population health outcomes, as timely diagnosis and treatment can prevent complications. Monitoring healthcare utilization patterns for conjunctival disorders can help identify trends and improve care strategies, ultimately enhancing patient satisfaction and quality measures in ophthalmic care.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for ophthalmic procedures and ensuring that the procedure codes align with the diagnosis. Common denials may arise from lack of specificity in documentation or failure to demonstrate medical necessity for treatment. Best practices include thorough documentation of the patient's symptoms, examination findings, and any treatments provided, as well as ensuring that the coding accurately reflects the services rendered.

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 H11.121?

H11.121 specifically covers conjunctival concretions in the right eye. It does not include other conjunctival disorders such as conjunctivitis or pterygium, which have separate codes.

When should H11.121 be used instead of related codes?

H11.121 should be used when the diagnosis is specifically conjunctival concretions in the right eye. If the condition affects the left eye, H11.122 should be used. For other conjunctival conditions, different codes apply.

What documentation supports H11.121?

Documentation should include a detailed ocular examination report, noting the presence of concretions, any associated symptoms, and the treatment plan. Photographic evidence may also be beneficial.