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 CodesH11.153

H11.153

Billable

Pinguecula, bilateral

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

Code Description

ICD-10 H11.153 is a billable code used to indicate a diagnosis of pinguecula, bilateral.

Key Diagnostic Point:

Pinguecula is a benign, yellowish, elevated growth on the conjunctiva, typically located on the nasal or temporal side of the eye. When bilateral, it affects both eyes, often resulting from chronic exposure to UV light, wind, and dust. Clinically, patients may present with irritation, redness, or a foreign body sensation, although many remain asymptomatic. The anatomy involved includes the conjunctiva, which is the thin 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 discomfort or cosmetic concerns. Diagnostic considerations include a thorough ocular examination, where the pinguecula's appearance and location are assessed. Differential diagnoses may include pterygium, conjunctival cysts, or other conjunctival lesions. Treatment is often conservative, focusing on lubricating eye drops or anti-inflammatory medications if symptoms arise.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low, as pinguecula is easily identifiable during a routine eye examination.
  • Treatment complexity: Low, with most cases requiring minimal intervention.
  • Documentation requirements: Moderate, necessitating clear descriptions of symptoms and examination findings.
  • Coding specificity: High, as H11.153 specifically denotes bilateral pinguecula.

Audit Risk Factors

  • Common coding errors: Misclassification with pterygium or other conjunctival lesions.
  • Documentation gaps: Incomplete symptom descriptions or lack of bilateral notation.
  • Billing challenges: Potential denials if the bilateral nature 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

Optometry

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

Pinguecula, while generally benign, can affect patient comfort and quality of life, particularly in populations with high UV exposure. Its prevalence is higher in individuals over 50 and those with significant sun exposure, impacting healthcare utilization patterns. Understanding the epidemiology of pinguecula can help in developing preventive measures and improving patient education regarding UV protection, ultimately enhancing population health outcomes.

ICD-9 vs ICD-10

Pinguecula, while generally benign, can affect patient comfort and quality of life, particularly in populations with high UV exposure. Its prevalence is higher in individuals over 50 and those with significant sun exposure, impacting healthcare utilization patterns. Understanding the epidemiology of pinguecula can help in developing preventive measures and improving patient education regarding UV protection, ultimately enhancing population health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the use of appropriate CPT codes for ophthalmological services, which may vary based on the complexity of the examination and any treatments provided. Common denials may arise from insufficient documentation or incorrect coding, emphasizing the need for thorough clinical notes that support the diagnosis and treatment plan.

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 H11.153?

H11.153 specifically covers bilateral pinguecula, characterized by yellowish conjunctival growths on both eyes, often due to environmental factors.

When should H11.153 be used instead of related codes?

H11.153 should be used when both eyes are affected by pinguecula, distinguishing it from unilateral codes like H11.151.

What documentation supports H11.153?

Documentation should include a detailed ocular examination report, noting the presence of pinguecula in both eyes, any symptoms, and treatment provided.