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ICD-10 Guide
ICD-10 CodesH11.123

H11.123

Billable

Conjunctival concretions, bilateral

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

Code Description

ICD-10 H11.123 is a billable code used to indicate a diagnosis of conjunctival concretions, bilateral.

Key Diagnostic Point:

Conjunctival concretions, also known as conjunctival cysts or concretions, are small, yellowish-white deposits that form on the conjunctiva, the clear membrane covering the white part of the eye and the inner eyelids. These concretions are typically composed of epithelial cells, mucus, and debris, and can occur bilaterally, affecting both eyes. Clinically, patients may present with symptoms such as irritation, foreign body sensation, or mild redness, although many cases are asymptomatic. The anatomy involved includes the conjunctiva, which plays a crucial role in protecting the eye and maintaining moisture. Disease progression is generally benign, but in some cases, larger concretions can lead to discomfort or secondary inflammation. Diagnostic considerations include a thorough eye examination, where the clinician may utilize a slit lamp to visualize the concretions. Differential diagnoses may include pterygium, pinguecula, or other conjunctival lesions, necessitating careful evaluation to rule out more serious conditions. Treatment may not be required unless symptoms are present, in which case removal of the concretions may be performed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires differentiation from other conjunctival lesions.
  • Treatment complexity: Low, as treatment is often unnecessary unless symptomatic.
  • Documentation requirements: Moderate, necessitating clear documentation of symptoms and examination findings.
  • Coding specificity: High, as H11.123 specifically denotes bilateral conjunctival concretions.

Audit Risk Factors

  • Common coding errors: Misuse of related codes for unilateral cases.
  • Documentation gaps: Lack of detailed symptom description or examination findings.
  • Billing challenges: Potential denials if the necessity for treatment 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

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 often asymptomatic, can impact patient quality of life if they cause discomfort. Understanding their prevalence and management is important for population health, as they are commonly encountered in ophthalmology. Effective documentation and coding can lead to better healthcare utilization patterns, ensuring that patients receive appropriate care without unnecessary procedures.

ICD-9 vs ICD-10

Conjunctival concretions, while often asymptomatic, can impact patient quality of life if they cause discomfort. Understanding their prevalence and management is important for population health, as they are commonly encountered in ophthalmology. Effective documentation and coding can lead to better healthcare utilization patterns, ensuring that patients receive appropriate care without unnecessary procedures.

Reimbursement & Billing Impact

Reimbursement may be affected by the presence of symptoms; therefore, a thorough examination report detailing any discomfort or irritation is crucial. Common denials may arise if the necessity for treatment is not well-documented. Coders should also be aware of payer-specific guidelines regarding the use of related CPT codes for any surgical interventions that may be 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 H11.123?

H11.123 specifically covers bilateral conjunctival concretions, which are benign lesions on the conjunctiva. It does not include other conjunctival disorders such as pterygium or conjunctivitis.

When should H11.123 be used instead of related codes?

H11.123 should be used when bilateral conjunctival concretions are diagnosed. If only one eye is affected, H11.121 should be used instead. Accurate documentation of the bilateral nature is essential.

What documentation supports H11.123?

Documentation should include a detailed eye examination report, noting the presence of concretions in both eyes, any associated symptoms, and the clinical decision-making process regarding treatment.