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ICD-10 Guide
ICD-10 CodesH11.219

H11.219

Billable

Conjunctival adhesions and strands (localized), unspecified eye

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

Code Description

ICD-10 H11.219 is a billable code used to indicate a diagnosis of conjunctival adhesions and strands (localized), unspecified eye.

Key Diagnostic Point:

Conjunctival adhesions and strands (localized), unspecified eye, refer to abnormal fibrous connections that can develop between the conjunctiva and adjacent ocular structures, such as the sclera or cornea. Clinically, patients may present with symptoms like discomfort, irritation, or visual disturbances, depending on the extent and location of the adhesions. The conjunctiva is a thin, transparent membrane covering the white part of the eyeball and the inner surface of the eyelids, playing a crucial role in ocular health. Disease progression can vary; localized adhesions may remain asymptomatic or lead to complications such as restricted eye movement or chronic inflammation. Diagnostic considerations include a thorough ocular examination, slit-lamp biomicroscopy, and possibly imaging studies to assess the extent of the adhesions. Differentiating between localized and generalized conjunctival conditions is essential for appropriate management and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a detailed ocular examination and possibly imaging.
  • Treatment complexity: May involve surgical intervention or conservative management.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis.
  • Coding specificity: Requires precise coding to differentiate from other conjunctival disorders.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of adhesion or eye involved.
  • Documentation gaps: Incomplete clinical notes may lead to denials.
  • Billing challenges: Variability in payer requirements for documentation and coding specificity.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of H11.219 lies in its potential to affect visual function and patient comfort. Conjunctival adhesions can lead to complications if left untreated, impacting overall ocular health. Understanding the epidemiology of conjunctival disorders can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures may include monitoring patient outcomes related to surgical interventions or conservative management of conjunctival conditions.

ICD-9 vs ICD-10

The clinical significance of H11.219 lies in its potential to affect visual function and patient comfort. Conjunctival adhesions can lead to complications if left untreated, impacting overall ocular health. Understanding the epidemiology of conjunctival disorders can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures may include monitoring patient outcomes related to surgical interventions or conservative management of conjunctival conditions.

Reimbursement & Billing Impact

Reimbursement may vary based on the payer, so it is crucial to verify coverage policies. Common denials may arise from insufficient documentation or incorrect coding. Best practices include using precise codes, maintaining thorough records, and ensuring that all services rendered are clearly linked to the diagnosis.

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 H11.219?

H11.219 covers localized conjunctival adhesions and strands that may arise due to trauma, surgery, or chronic inflammation. It does not specify the underlying cause, which may include conditions like conjunctivitis or post-surgical changes.

When should H11.219 be used instead of related codes?

H11.219 should be used when the clinician identifies localized conjunctival adhesions without specifying the eye or when the condition is not adequately described by other codes. It is essential to ensure that the clinical documentation supports the diagnosis.

What documentation supports H11.219?

Documentation should include a comprehensive ocular examination report, details of the patient's symptoms, any relevant history of trauma or surgery, and findings from diagnostic tests such as slit-lamp examination.