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ICD-10 Guide
ICD-10 CodesH11.151

H11.151

Billable

Pinguecula, right eye

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

Code Description

ICD-10 H11.151 is a billable code used to indicate a diagnosis of pinguecula, right eye.

Key Diagnostic Point:

Pinguecula is a benign growth of the conjunctiva, typically appearing as a yellowish, raised lesion on the conjunctiva adjacent to the cornea. It is most commonly found on the nasal side of the right eye, leading to the designation H11.151. The condition is primarily associated with prolonged exposure to ultraviolet light, dust, and wind, which can cause irritation and inflammation of the conjunctival tissue. Clinically, patients may present with symptoms such as dryness, irritation, or a foreign body sensation, although many remain asymptomatic. The anatomy involved includes the conjunctiva, which is the thin, transparent membrane covering the sclera and lining the eyelids. Disease progression is generally slow, and while pingueculae are not typically associated with significant visual impairment, they can lead to secondary complications such as pterygium if left untreated. Diagnostic considerations include a thorough eye examination, where the growth is assessed for size, location, and associated symptoms. Differential diagnoses may include conjunctival cysts or other conjunctival lesions, necessitating careful evaluation.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low - Diagnosis is straightforward with clinical examination.
  • Treatment complexity: Low - Treatment options are minimal, often involving observation or lubricating drops.
  • Documentation requirements: Medium - Requires clear documentation of symptoms and examination findings.
  • Coding specificity: Medium - Specific to the right eye, but related codes exist for other locations.

Audit Risk Factors

  • Common coding errors: Misidentification of the lesion type or location.
  • Documentation gaps: Incomplete records of symptoms or examination findings.
  • Billing challenges: Potential denials if the condition is not well-documented or if treatment is deemed unnecessary.

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

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 exposed to high levels of UV light, such as outdoor workers. Its clinical significance lies in its potential to cause discomfort and irritation, impacting quality of life. While generally benign, the presence of pinguecula can lead to increased healthcare utilization due to associated symptoms or complications. Understanding the epidemiology of pinguecula can help in developing preventive strategies and improving patient education regarding UV protection.

ICD-9 vs ICD-10

Pinguecula is a common condition, particularly in populations exposed to high levels of UV light, such as outdoor workers. Its clinical significance lies in its potential to cause discomfort and irritation, impacting quality of life. While generally benign, the presence of pinguecula can lead to increased healthcare utilization due to associated symptoms or complications. Understanding the epidemiology of pinguecula can help in developing preventive strategies and improving patient education regarding UV protection.

Reimbursement & Billing Impact

Reimbursement considerations may vary by payer, but typically, pinguecula treatment is considered a low-cost procedure. Common denials may arise from insufficient documentation or if the treatment is perceived as cosmetic rather than medically necessary. It is crucial to follow coding best practices, including using the most specific code available and ensuring that all documentation supports the diagnosis and any procedures 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 H11.151?

H11.151 specifically covers pinguecula located in the right eye. It is characterized by a yellowish, raised lesion on the conjunctiva, often associated with environmental factors such as UV exposure.

When should H11.151 be used instead of related codes?

H11.151 should be used when the pinguecula is specifically located in the right eye. If the lesion is in the left eye, H11.152 should be used, and for bilateral cases, H11.153 is appropriate.

What documentation supports H11.151?

Documentation should include a detailed eye examination report noting the presence, size, and location of the pinguecula, as well as any symptoms reported by the patient. Photographic evidence may also support the diagnosis.