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 CodesH11.159

H11.159

Billable

Pinguecula, unspecified eye

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

Code Description

ICD-10 H11.159 is a billable code used to indicate a diagnosis of pinguecula, unspecified eye.

Key Diagnostic Point:

Pinguecula is a benign, yellowish, elevated growth on the conjunctiva, often occurring on the nasal side of the eye. It is primarily composed of collagen and elastic tissue and is associated with chronic exposure to UV light, dust, and wind. 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 clear membrane covering the white part of the eye (sclera) and the inner surface of the eyelids. Disease progression is generally slow, and while pingueculae are not typically associated with significant visual impairment, they can lead to discomfort and cosmetic concerns. Diagnostic considerations include a thorough eye examination, where the pinguecula's appearance is assessed, and differential diagnoses may include pterygium or conjunctival cysts. Treatment is often conservative, focusing on lubricating eye drops or anti-inflammatory medications if symptoms arise. Surgical intervention may be considered for symptomatic or cosmetically concerning lesions.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low, as pinguecula is easily identifiable during a routine eye exam.
  • Treatment complexity: Low, with most cases managed conservatively.
  • Documentation requirements: Moderate, requiring clear documentation of symptoms and examination findings.
  • Coding specificity: Moderate, as it is important to differentiate from similar conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with pterygium or other conjunctival lesions.
  • Documentation gaps: Lack of detailed symptom description or examination findings.
  • Billing challenges: Potential denials if the condition 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 affect quality of life, although it rarely leads to serious complications. Understanding the epidemiology of pinguecula can inform public health initiatives aimed at UV protection and eye health awareness, ultimately impacting healthcare utilization patterns as patients seek treatment for symptomatic cases.

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 affect quality of life, although it rarely leads to serious complications. Understanding the epidemiology of pinguecula can inform public health initiatives aimed at UV protection and eye health awareness, ultimately impacting healthcare utilization patterns as patients seek treatment for symptomatic cases.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the services provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for treatment. Best practices include maintaining detailed records of patient interactions and ensuring that coding aligns with the documented clinical picture.

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 H11.159?

H11.159 specifically covers pinguecula of the unspecified eye, which is a benign growth on the conjunctiva. It does not include pterygium or other conjunctival disorders.

When should H11.159 be used instead of related codes?

H11.159 should be used when the pinguecula is not specified as occurring in the right or left eye, or when the exact location of the lesion is not documented.

What documentation supports H11.159?

Documentation should include a detailed eye examination report noting the presence of the pinguecula, any associated symptoms, and the absence of other conjunctival conditions.