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ICD-10 Guide
ICD-10 CodesH11.222

H11.222

Billable

Conjunctival granuloma, left eye

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

Code Description

ICD-10 H11.222 is a billable code used to indicate a diagnosis of conjunctival granuloma, left eye.

Key Diagnostic Point:

Conjunctival granuloma, specifically in the left eye, is a localized inflammatory lesion that arises from various underlying causes, including foreign body reactions, infections, or chronic irritation. Clinically, patients may present with a red, swollen area on the conjunctiva, which may be asymptomatic or associated with discomfort, tearing, or visual disturbances. The conjunctiva is the membrane covering the white part of the eyeball and the inner eyelids, and its inflammation can lead to complications if not addressed. Disease progression can vary; some granulomas may resolve spontaneously, while others may persist or enlarge, necessitating intervention. Diagnostic considerations include a thorough ocular examination, patient history, and possibly imaging or biopsy to rule out malignancy or other conditions. Differential diagnoses include conjunctival cysts, papillomas, and other conjunctival lesions, making accurate diagnosis crucial for effective management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differential diagnosis and potential biopsy.
  • Treatment complexity: May involve surgical excision or corticosteroid injections.
  • Documentation requirements: Detailed clinical notes and history are essential.
  • Coding specificity: Requires precise coding to differentiate from other conjunctival disorders.

Audit Risk Factors

  • Common coding errors: Misidentifying the laterality or type of granuloma.
  • Documentation gaps: Incomplete patient history or lack of imaging results.
  • Billing challenges: Potential denials due to insufficient documentation or incorrect coding.

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

Allergy and Immunology

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

Conjunctival granulomas, while often benign, can significantly impact patient quality of life due to discomfort and potential visual disturbances. Understanding the epidemiology of conjunctival lesions helps in identifying at-risk populations and improving healthcare utilization patterns. Effective management of these conditions can lead to better patient outcomes and reduced healthcare costs, aligning with quality measures aimed at enhancing patient care in ophthalmology.

ICD-9 vs ICD-10

Conjunctival granulomas, while often benign, can significantly impact patient quality of life due to discomfort and potential visual disturbances. Understanding the epidemiology of conjunctival lesions helps in identifying at-risk populations and improving healthcare utilization patterns. Effective management of these conditions can lead to better patient outcomes and reduced healthcare costs, aligning with quality measures aimed at enhancing patient care in ophthalmology.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for ophthalmological procedures and ensuring that all necessary documentation is submitted to avoid denials. Common denials may arise from incomplete documentation or failure to provide adequate justification for the procedure performed. Best practices include maintaining thorough clinical notes, obtaining prior authorizations when necessary, and 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 H11.222?

H11.222 specifically covers conjunctival granulomas in the left eye, which may arise from foreign bodies, infections, or chronic irritation. It does not cover other conjunctival lesions such as cysts or tumors.

When should H11.222 be used instead of related codes?

H11.222 should be used when the diagnosis is specifically a conjunctival granuloma in the left eye, as opposed to other conditions like conjunctival cysts or granulomas in the right eye (H11.221).

What documentation supports H11.222?

Documentation should include a detailed ocular examination, patient history indicating symptoms and potential causes, and any imaging or biopsy results that confirm the diagnosis of a conjunctival granuloma.