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ICD-10 Guide
ICD-10 CodesH11.133

H11.133

Billable

Conjunctival pigmentations, bilateral

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

Code Description

ICD-10 H11.133 is a billable code used to indicate a diagnosis of conjunctival pigmentations, bilateral.

Key Diagnostic Point:

H11.133 refers to bilateral conjunctival pigmentations, which are characterized by the presence of pigmented lesions on the conjunctiva, the clear membrane covering the white part of the eye. These pigmentations can be benign or indicative of underlying conditions. Clinically, patients may present with asymptomatic lesions, or they may report irritation or cosmetic concerns. The conjunctiva is a crucial part of the ocular surface, and any changes in its appearance can be significant. Disease progression can vary; while some pigmentations remain stable, others may change in size or color, necessitating further evaluation. Diagnostic considerations include a thorough ocular examination, possibly supplemented by imaging techniques or biopsy to rule out malignancy or other pathologies. It is essential to differentiate these pigmentations from other conjunctival disorders, such as conjunctival nevi or melanosis, which may require different management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful evaluation to differentiate from other conditions.
  • Treatment complexity: Management may vary based on the underlying cause.
  • Documentation requirements: Detailed clinical notes are necessary to support diagnosis.
  • Coding specificity: Requires accurate coding to reflect the bilateral nature of the condition.

Audit Risk Factors

  • Common coding errors: Misclassification of unilateral vs. bilateral conditions.
  • Documentation gaps: Incomplete clinical notes regarding the nature and assessment of pigmentations.
  • Billing challenges: Potential denials if the medical necessity is not clearly established.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of H11.133 lies in its potential to indicate underlying ocular or systemic conditions. Understanding the prevalence of conjunctival pigmentations can aid in population health assessments, as these lesions may reflect broader health issues. Quality measures may include monitoring changes in pigmentation and ensuring timely referrals for further evaluation. Epidemiologically, the presence of conjunctival pigmentations can influence healthcare utilization patterns, as patients may seek care for cosmetic reasons or due to associated symptoms.

ICD-9 vs ICD-10

The clinical significance of H11.133 lies in its potential to indicate underlying ocular or systemic conditions. Understanding the prevalence of conjunctival pigmentations can aid in population health assessments, as these lesions may reflect broader health issues. Quality measures may include monitoring changes in pigmentation and ensuring timely referrals for further evaluation. Epidemiologically, the presence of conjunctival pigmentations can influence healthcare utilization patterns, as patients may seek care for cosmetic reasons or due to associated symptoms.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the services provided are medically necessary and appropriately documented. Common denials may arise from insufficient documentation or failure to demonstrate the need for the examination. Coders should ensure that the diagnosis aligns with the services billed and that all relevant modifiers are applied when necessary. Best practices include maintaining clear and thorough clinical notes and using appropriate CPT codes that correspond with the level of service provided.

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 H11.133?

H11.133 encompasses bilateral conjunctival pigmentations, which may include benign lesions like conjunctival nevi or more concerning conditions such as conjunctival melanoma. The diagnosis is based on clinical examination and may require histopathological confirmation.

When should H11.133 be used instead of related codes?

H11.133 should be used when bilateral conjunctival pigmentations are present, particularly when they are symptomatic or require monitoring. If the pigmentations are unilateral, H11.132 should be selected instead.

What documentation supports H11.133?

Documentation should include a detailed ocular examination, description of the pigmentations, any associated symptoms, and the rationale for diagnosis. Photographic evidence may also be beneficial for tracking changes over time.