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ICD-10 Guide
ICD-10 CodesH11.231

H11.231

Billable

Symblepharon, right eye

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

Code Description

ICD-10 H11.231 is a billable code used to indicate a diagnosis of symblepharon, right eye.

Key Diagnostic Point:

Symblepharon is a condition characterized by the adhesion of the conjunctiva to the eyeball or eyelid, which can occur in the right eye as indicated by the code H11.231. This condition may arise from various etiologies, including trauma, chemical burns, or inflammatory diseases affecting the conjunctiva. The conjunctiva is a thin, transparent membrane that covers the white part of the eyeball and the inner surface of the eyelids, playing a crucial role in protecting the eye and maintaining moisture. Symblepharon can lead to significant discomfort, visual impairment, and complications such as corneal scarring or exposure keratitis if not addressed promptly. The disease progression may vary, with some patients experiencing mild symptoms while others may develop severe complications requiring surgical intervention. Diagnostic considerations include a thorough ocular examination, patient history, and possibly imaging studies to assess the extent of the adhesion and any associated ocular surface disorders. Early diagnosis and management are essential to prevent long-term sequelae and preserve visual function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough ocular examination and patient history.
  • Treatment complexity: May involve surgical intervention depending on severity.
  • Documentation requirements: Detailed clinical notes and imaging may be necessary.
  • Coding specificity: Requires precise coding to differentiate from other conjunctival disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the eye involved or confusion with similar conditions.
  • Documentation gaps: Incomplete clinical notes regarding the extent of the condition.
  • Billing challenges: Potential denials if the medical necessity 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

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, leading to discomfort and visual impairment. The condition may affect population health by increasing the need for surgical interventions and follow-up care. Understanding the epidemiology of symblepharon, including its causes and prevalence, can help healthcare providers develop targeted prevention and treatment strategies, ultimately improving patient outcomes and reducing healthcare utilization.

ICD-9 vs ICD-10

Symblepharon can significantly impact a patient's quality of life, leading to discomfort and visual impairment. The condition may affect population health by increasing the need for surgical interventions and follow-up care. Understanding the epidemiology of symblepharon, including its causes and prevalence, can help healthcare providers develop targeted prevention and treatment strategies, ultimately improving patient outcomes and reducing healthcare utilization.

Reimbursement & Billing Impact

Reimbursement considerations may vary by payer, so it is essential to verify coverage policies. Common denials may arise from lack of medical necessity documentation or insufficient detail in the clinical notes. Coders should ensure that the procedure codes used align with the diagnosis and that all relevant modifiers are applied to avoid billing issues. Best practices include maintaining clear and comprehensive documentation of the patient's condition 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 H11.231?

H11.231 specifically covers cases of symblepharon affecting the right eye, which may result from trauma, surgery, or inflammatory conditions. It does not cover other conjunctival disorders such as conjunctivitis or pterygium.

When should H11.231 be used instead of related codes?

H11.231 should be used when there is a confirmed diagnosis of symblepharon in the right eye, distinguishing it from other conditions that may affect the conjunctiva or eyelids, such as H11.230 for unspecified symblepharon.

What documentation supports H11.231?

Documentation should include a detailed ocular examination report, patient history indicating the cause of symblepharon, and any imaging studies that demonstrate the condition's extent. Surgical notes may also be necessary if treatment has been performed.