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ICD-10 Guide
ICD-10 CodesH11.23

H11.23

Non-billable

Symblepharon

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

Code Description

ICD-10 H11.23 is a used to indicate a diagnosis of symblepharon.

Key Diagnostic Point:

Symblepharon is a condition characterized by the adhesion of the conjunctiva to the eyelid or to the globe, which can result from various etiologies including trauma, inflammation, or surgical interventions. Clinically, patients may present with symptoms such as discomfort, restricted eye movement, and visual disturbances due to corneal exposure or scarring. The anatomy involved primarily includes the conjunctiva, eyelids, and potentially the cornea and sclera, depending on the extent of the adhesion. Disease progression can lead to complications such as dry eye syndrome, corneal ulceration, and vision loss if left untreated. Diagnostic considerations include a thorough ocular examination, slit-lamp biomicroscopy, and possibly imaging studies to assess the extent of the symblepharon and associated ocular surface disease. Treatment options may involve surgical intervention to release the adhesions, along with supportive care for any underlying conditions contributing to the formation of symblepharon.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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

Plastic Surgery

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

Symblepharon can significantly impact a patient's quality of life by causing discomfort and visual impairment. Understanding its prevalence and treatment can aid in improving population health outcomes. Quality measures may include tracking surgical outcomes and patient satisfaction post-treatment. Epidemiologically, symblepharon is more common in populations with higher rates of ocular trauma or inflammatory conditions.

ICD-9 vs ICD-10

Symblepharon can significantly impact a patient's quality of life by causing discomfort and visual impairment. Understanding its prevalence and treatment can aid in improving population health outcomes. Quality measures may include tracking surgical outcomes and patient satisfaction post-treatment. Epidemiologically, symblepharon is more common in populations with higher rates of ocular trauma or inflammatory conditions.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the surgical intervention and the necessity for follow-up care. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the procedure. Best practices include ensuring that all clinical findings are clearly documented and that the coding accurately reflects the 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 H11.23?

H11.23 specifically covers symblepharon, which may arise from conditions such as chemical burns, surgical trauma, or chronic inflammatory diseases affecting the conjunctiva.

When should H11.23 be used instead of related codes?

H11.23 should be used when there is clear documentation of conjunctival adhesion specifically termed symblepharon, differentiating it from other conjunctival or eyelid disorders.

What documentation supports H11.23?

Documentation should include a detailed ocular examination report, clinical findings indicating the presence of symblepharon, and any relevant imaging studies that support the diagnosis.