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ICD-10 Guide
ICD-10 CodesH11.241

H11.241

Billable

Scarring of conjunctiva, right eye

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

Code Description

ICD-10 H11.241 is a billable code used to indicate a diagnosis of scarring of conjunctiva, right eye.

Key Diagnostic Point:

H11.241 refers to scarring of the conjunctiva in the right eye, a condition that can arise from various etiologies including trauma, chronic inflammation, or surgical interventions. The conjunctiva is a thin, transparent membrane that covers the white part of the eyeball and the inner surface of the eyelids. Scarring can lead to symptoms such as irritation, redness, and discomfort, and may significantly impact visual acuity if it extends to adjacent structures. The disease progression often involves the formation of fibrous tissue that can restrict movement of the eyelids or cause discomfort during blinking. Diagnostic considerations include a thorough ocular examination, slit-lamp biomicroscopy, and possibly imaging studies to assess the extent of scarring and rule out associated conditions like conjunctival cysts or pterygium. Management may involve topical medications, surgical intervention for severe cases, and regular monitoring to prevent complications such as secondary infections or further visual impairment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive ocular examination and potential imaging.
  • Treatment complexity: May involve medical management and surgical options.
  • Documentation requirements: Detailed clinical notes and treatment plans are necessary.
  • Coding specificity: Requires precise coding to differentiate from other conjunctival disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the eye affected or confusion with other conjunctival conditions.
  • Documentation gaps: Incomplete clinical notes regarding the extent of scarring or treatment provided.
  • Billing challenges: Potential denials if documentation does not support the diagnosis or treatment.

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 H11.241 lies in its potential to affect visual function and quality of life. Scarring of the conjunctiva can lead to discomfort and complications, necessitating timely intervention. Population health impact includes the need for ongoing monitoring and treatment in affected individuals, which can influence healthcare utilization patterns. Understanding the epidemiology of conjunctival scarring is essential for developing effective preventive strategies and improving patient outcomes.

ICD-9 vs ICD-10

The clinical significance of H11.241 lies in its potential to affect visual function and quality of life. Scarring of the conjunctiva can lead to discomfort and complications, necessitating timely intervention. Population health impact includes the need for ongoing monitoring and treatment in affected individuals, which can influence healthcare utilization patterns. Understanding the epidemiology of conjunctival scarring is essential for developing effective preventive strategies and improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the medical necessity of the treatment provided, whether it be medical management or surgical intervention. Common denials may arise from insufficient documentation or failure to demonstrate the necessity of the procedure. Coders should ensure that all relevant clinical information is included in the patient’s record to support the claim and reduce the risk of audits.

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 H11.241?

H11.241 specifically covers scarring of the conjunctiva in the right eye, which may result from conditions such as chemical burns, chronic conjunctivitis, or surgical procedures. It is important to document the underlying cause of the scarring for accurate coding.

When should H11.241 be used instead of related codes?

H11.241 should be used when there is documented scarring of the conjunctiva specifically in the right eye. If the scarring is in the left eye, H11.240 should be used. Additionally, if the scarring is part of a broader condition affecting the conjunctiva, a different code may be more appropriate.

What documentation supports H11.241?

Documentation should include a detailed ocular examination report, noting the extent and cause of the conjunctival scarring, treatment plans, and any relevant imaging studies. Clinical notes should clearly indicate the diagnosis and any associated symptoms.