Code Description

ICD-10 H11.30 is a billable code used to indicate a diagnosis of conjunctival hemorrhage, unspecified eye.

Key Diagnostic Point:

Conjunctival hemorrhage, also known as subconjunctival hemorrhage, is characterized by the presence of blood in the conjunctival sac, which can occur in one or both eyes. The conjunctiva is a thin, transparent membrane that covers the white part of the eye (sclera) and the inner surface of the eyelids. This condition may present as a bright red patch on the sclera, often without accompanying pain or visual disturbance. Common causes include trauma, increased venous pressure due to coughing or straining, anticoagulant therapy, or systemic conditions such as hypertension. The progression of conjunctival hemorrhage is generally benign, with most cases resolving spontaneously within one to two weeks. Diagnostic considerations include a thorough history and physical examination to rule out underlying systemic diseases or ocular trauma. While the condition is usually self-limiting, persistent or recurrent hemorrhages may warrant further investigation to exclude more serious ocular or systemic conditions.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

Diagnostic complexity: Low, as the diagnosis is often straightforward based on clinical presentation.
Treatment complexity: Low, as most cases resolve without intervention.
Documentation requirements: Moderate, requiring clear documentation of the clinical findings and any relevant history.
Coding specificity: Moderate, as it is important to differentiate between types of hemorrhages.

Audit Risk Factors

Common coding errors: Misclassification of the type of hemorrhage or eye involved.
Documentation gaps: Incomplete patient history or lack of follow-up notes.
Billing challenges: Potential denials due to insufficient documentation supporting the diagnosis.

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

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CPT Code

Clinical Scenario

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CPT Code

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CPT Code

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ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Conjunctival hemorrhage is a common ocular condition that can affect a significant portion of the population, particularly among older adults and those on anticoagulant therapy. While generally benign, its presence can lead to increased healthcare utilization due to patient anxiety and the need for reassurance. Understanding the epidemiology of conjunctival hemorrhage can help healthcare providers better manage patient expectations and improve quality measures related to eye health.

ICD-9 vs ICD-10

Conjunctival hemorrhage is a common ocular condition that can affect a significant portion of the population, particularly among older adults and those on anticoagulant therapy. While generally benign, its presence can lead to increased healthcare utilization due to patient anxiety and the need for reassurance. Understanding the epidemiology of conjunctival hemorrhage can help healthcare providers better manage patient expectations and improve quality measures related to eye health.

Reimbursement & Billing Impact

Conjunctival hemorrhage is a common ocular condition that can affect a significant portion of the population, particularly among older adults and those on anticoagulant therapy. While generally benign, its presence can lead to increased healthcare utilization due to patient anxiety and the need for reassurance. Understanding the epidemiology of conjunctival hemorrhage can help healthcare providers better manage patient expectations and improve quality measures related to eye health.

Resources

Clinical References

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ICD-10 Official Guidelines for H00-H99
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Clinical Documentation Requirements

Coding & Billing References

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ICD-10 Official Guidelines for H00-H99
•
Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by H11.30?

H11.30 covers cases of conjunctival hemorrhage where the specific eye is not indicated. It includes hemorrhages due to trauma, systemic conditions, or idiopathic causes without further specification.

When should H11.30 be used instead of related codes?

H11.30 should be used when the specific eye affected is not documented or when the hemorrhage is bilateral and unspecified. If the eye is specified, use H11.31 or H11.32.

What documentation supports H11.30?

Documentation should include a detailed description of the conjunctival findings, any relevant history of trauma or systemic conditions, and a plan for follow-up if necessary.