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ICD-10 Guide
ICD-10 CodesH11.13

H11.13

Non-billable

Conjunctival pigmentations

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

Code Description

ICD-10 H11.13 is a used to indicate a diagnosis of conjunctival pigmentations.

Key Diagnostic Point:

Conjunctival pigmentations refer to the presence of abnormal pigmentation on the conjunctiva, which is the clear membrane covering the white part of the eye and the inner surface of the eyelids. These pigmentations can manifest as various lesions, including nevi, melanosis, or other pigmented lesions. Clinically, patients may present with asymptomatic lesions, or in some cases, they may experience irritation or cosmetic concerns. The conjunctiva is a vital part of the anterior segment of the eye, and its health is crucial for overall ocular function. Disease progression can vary; while some pigmentations are benign and stable, others may indicate underlying pathology, such as conjunctival melanoma. Diagnostic considerations include a thorough ocular examination, possibly supplemented by imaging techniques or biopsy to determine the nature of the pigmentation. It is essential to differentiate between benign and malignant lesions to guide appropriate management and treatment options.

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

Dermatology

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

Conjunctival pigmentations can significantly impact patient quality of life, especially if they cause cosmetic concerns or are symptomatic. Understanding the epidemiology of these conditions is crucial for population health, as certain types of pigmentations may have a higher incidence in specific demographics. Effective management and early detection can improve healthcare utilization patterns and reduce the risk of progression to malignancy, thereby enhancing overall patient outcomes.

ICD-9 vs ICD-10

Conjunctival pigmentations can significantly impact patient quality of life, especially if they cause cosmetic concerns or are symptomatic. Understanding the epidemiology of these conditions is crucial for population health, as certain types of pigmentations may have a higher incidence in specific demographics. Effective management and early detection can improve healthcare utilization patterns and reduce the risk of progression to malignancy, thereby enhancing overall patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the examination and any additional procedures performed, such as biopsies. Documentation must clearly outline the nature of the conjunctival pigmentation, any symptoms, and the rationale for any treatments provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Adhering to coding best practices, including using modifiers when necessary, can help mitigate these challenges.

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 H11.13?

H11.13 covers various forms of conjunctival pigmentations, including conjunctival nevi, melanosis, and other pigmented lesions. It is important to assess the characteristics of these lesions to determine if they are benign or require further investigation.

When should H11.13 be used instead of related codes?

H11.13 should be used when the primary diagnosis is specifically related to conjunctival pigmentations. If the condition involves other ocular structures or is primarily a cyst or lesion, other codes such as H11.12 or H11.14 may be more appropriate.

What documentation supports H11.13?

Documentation for H11.13 should include a detailed ocular examination report, descriptions of the pigmentation characteristics, any symptoms reported by the patient, and any imaging or biopsy results that support the diagnosis.