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ICD-10 Guide
ICD-10 CodesH11.3

H11.3

Non-billable

Conjunctival hemorrhage

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

Code Description

ICD-10 H11.3 is a used to indicate a diagnosis of conjunctival hemorrhage.

Key Diagnostic Point:

Conjunctival hemorrhage, also known as subconjunctival hemorrhage, is characterized by the presence of blood in the conjunctival sac, resulting from the rupture of small blood vessels in the conjunctiva. Clinically, it presents as a bright red patch on the white part of the eye (sclera) and is often asymptomatic, although patients may report mild discomfort or a sensation of fullness. The conjunctiva is a thin, transparent membrane covering the sclera and lining the eyelids, playing a crucial role in eye protection and lubrication. Common causes of conjunctival hemorrhage include trauma, increased venous pressure (such as from coughing or straining), anticoagulant therapy, and systemic conditions like hypertension. Disease progression is typically benign, with spontaneous resolution within 1-2 weeks. Diagnostic considerations include a thorough history and physical examination to rule out underlying conditions such as bleeding disorders or ocular trauma. In cases where the hemorrhage is recurrent or associated with other symptoms, further investigation may be warranted to assess for systemic causes or ocular pathology.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low - typically straightforward diagnosis based on clinical presentation.
  • Treatment complexity: Low - often requires no treatment; reassurance is usually sufficient.
  • Documentation requirements: Low - basic documentation of clinical findings and patient history.
  • Coding specificity: Medium - while H11.3 is specific, it may require differentiation from other hemorrhagic conditions.

Audit Risk Factors

  • Common coding errors: Misuse of related codes or failure to specify the nature of the hemorrhage.
  • Documentation gaps: Incomplete patient history or lack of follow-up notes.
  • Billing challenges: Potential denials if the condition is not clearly documented as benign.

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

Primary Care

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Conjunctival hemorrhage is a common ocular condition that can affect individuals of all ages, often leading to unnecessary anxiety due to its alarming appearance. Understanding its benign nature is crucial for both patients and healthcare providers. The condition has minimal impact on population health, but awareness can reduce unnecessary healthcare utilization and improve patient education. Quality measures may include follow-up assessments to ensure resolution and patient satisfaction with care.

ICD-9 vs ICD-10

Conjunctival hemorrhage is a common ocular condition that can affect individuals of all ages, often leading to unnecessary anxiety due to its alarming appearance. Understanding its benign nature is crucial for both patients and healthcare providers. The condition has minimal impact on population health, but awareness can reduce unnecessary healthcare utilization and improve patient education. Quality measures may include follow-up assessments to ensure resolution and patient satisfaction with care.

Reimbursement & Billing Impact

Reimbursement considerations include the need for thorough documentation that supports the diagnosis as benign. Common denials may arise if the documentation does not clearly indicate the nature of the hemorrhage or if follow-up care is not adequately recorded. Best practices include using appropriate CPT codes for any examinations or consultations performed, ensuring that all services rendered are justified by the clinical findings.

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 H11.3?

H11.3 specifically covers conjunctival hemorrhage, which can arise from various causes including trauma, systemic conditions, or idiopathic origins. It does not cover other conjunctival disorders such as conjunctivitis or neoplasms.

When should H11.3 be used instead of related codes?

H11.3 should be used when the primary diagnosis is a conjunctival hemorrhage without associated conditions. If there are additional symptoms or complications, other codes may be more appropriate.

What documentation supports H11.3?

Documentation should include a detailed patient history, clinical findings, and any relevant imaging or tests performed. Notes should clarify the benign nature of the hemorrhage and any follow-up care provided.