ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesH11.15

H11.15

Non-billable

Pinguecula

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

Code Description

ICD-10 H11.15 is a used to indicate a diagnosis of pinguecula.

Key Diagnostic Point:

Pinguecula is a benign, yellowish, elevated growth that occurs on the conjunctiva, typically on the nasal side of the eye. It is composed of a thickening of the conjunctival tissue and is often associated with exposure to UV light, dust, and wind. Clinically, pingueculae present as asymptomatic lesions but may cause irritation, redness, or a foreign body sensation in some patients. The anatomy involved includes the conjunctiva, which is the clear membrane covering the white part of the eye and the inner eyelids. Disease progression is generally slow, and while pingueculae are not typically associated with significant vision impairment, they can lead to complications such as pterygium if left untreated. Diagnostic considerations include a thorough eye examination, where the growth's appearance and location are assessed. Differential diagnoses may include conjunctival cysts or other conjunctival lesions. Treatment is usually conservative, focusing on lubrication and anti-inflammatory medications, but surgical removal may be considered for symptomatic cases or cosmetic concerns.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low - diagnosis is typically straightforward based on clinical examination.
  • Treatment complexity: Low - management is often conservative.
  • Documentation requirements: Low - basic documentation of symptoms and examination findings is sufficient.
  • Coding specificity: Medium - while specific, it is straightforward with limited variations.

Audit Risk Factors

  • Common coding errors: Misidentification of the lesion type or confusion with pterygium.
  • Documentation gaps: Incomplete records of patient symptoms or treatment rationale.
  • Billing challenges: Potential denials if the diagnosis is not clearly documented as benign.

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

Pinguecula is a common condition, particularly in populations with high UV exposure, such as outdoor workers. Its clinical significance lies in its potential to cause discomfort and irritation, impacting quality of life. While generally benign, understanding its epidemiology helps in preventive measures, such as UV protection. Quality measures may include monitoring the incidence of symptomatic cases and ensuring appropriate management to prevent progression to more serious conditions.

ICD-9 vs ICD-10

Pinguecula is a common condition, particularly in populations with high UV exposure, such as outdoor workers. Its clinical significance lies in its potential to cause discomfort and irritation, impacting quality of life. While generally benign, understanding its epidemiology helps in preventive measures, such as UV protection. Quality measures may include monitoring the incidence of symptomatic cases and ensuring appropriate management to prevent progression to more serious conditions.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, but typically, conservative management is covered under routine eye care. Common denials may arise if the diagnosis is not well-documented or if the treatment provided does not align with the diagnosis. Best practices include thorough documentation of the clinical findings and any patient complaints, as well as ensuring that the coding accurately reflects the diagnosis and treatment 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 H11.15?

H11.15 specifically covers pinguecula, a benign conjunctival growth. It does not cover related conditions like pterygium or conjunctival cysts, which have different ICD-10 codes.

When should H11.15 be used instead of related codes?

H11.15 should be used when the diagnosis is specifically pinguecula, characterized by its yellowish appearance and location on the conjunctiva, distinguishing it from pterygium (H11.14) which involves the cornea.

What documentation supports H11.15?

Documentation should include a detailed eye examination report noting the presence of a pinguecula, patient symptoms, and any treatment provided, including conservative management or surgical intervention if applicable.