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ICD-10 Guide
ICD-10 CodesH11.43

H11.43

Non-billable

Conjunctival hyperemia

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

Code Description

ICD-10 H11.43 is a used to indicate a diagnosis of conjunctival hyperemia.

Key Diagnostic Point:

Conjunctival hyperemia is characterized by the dilation of conjunctival blood vessels, leading to a red or inflamed appearance of the eye. This condition can arise from various etiologies, including infections, allergies, irritants, or systemic diseases. The conjunctiva, a thin membrane covering the sclera and lining the eyelids, plays a crucial role in eye health. When inflamed, it can lead to discomfort, tearing, and visual disturbances. Disease progression may vary; acute cases often resolve with appropriate treatment, while chronic hyperemia may indicate underlying conditions such as dry eye syndrome or autoimmune disorders. Diagnostic considerations include a thorough patient history, physical examination, and possibly additional tests such as conjunctival swabs or allergy testing to identify the underlying cause. Understanding the anatomy involved—particularly the conjunctiva, sclera, and anterior segment—is essential for accurate diagnosis and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Common coding errors include misidentifying the cause of hyperemia.
  • Documentation gaps may arise if the underlying cause is not clearly stated.
  • Billing challenges can occur if the condition is not well-documented or if there is a lack of specificity in 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

Allergy and Immunology

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Conjunctival hyperemia can significantly impact patient quality of life, leading to discomfort and visual disturbances. Its prevalence in the population is influenced by environmental factors, allergies, and infections. Understanding and managing this condition is crucial for improving patient outcomes and reducing healthcare utilization, as untreated hyperemia can lead to complications such as chronic eye conditions.

ICD-9 vs ICD-10

Conjunctival hyperemia can significantly impact patient quality of life, leading to discomfort and visual disturbances. Its prevalence in the population is influenced by environmental factors, allergies, and infections. Understanding and managing this condition is crucial for improving patient outcomes and reducing healthcare utilization, as untreated hyperemia can lead to complications such as chronic eye conditions.

Reimbursement & Billing Impact

Reimbursement considerations include the need for specificity in the diagnosis and the potential for denials if the underlying cause is not well-documented. Common denials may arise from insufficient documentation or lack of clarity regarding the patient's symptoms and treatment plan. Best practices include ensuring that all relevant clinical information is included in the patient's medical record and that the coding accurately reflects the complexity of the condition.

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 H11.43?

H11.43 encompasses conjunctival hyperemia resulting from allergic reactions, infections (such as conjunctivitis), environmental irritants, or systemic conditions like autoimmune diseases. It is essential to differentiate these causes for accurate treatment.

When should H11.43 be used instead of related codes?

H11.43 should be used when the primary issue is conjunctival hyperemia without significant edema or hemorrhage. If other symptoms or conditions are present, related codes like H11.42 or H11.41 may be more appropriate.

What documentation supports H11.43?

Documentation should include a detailed patient history, findings from the eye examination, and any diagnostic tests performed. Clear notes on the cause of hyperemia and treatment plans are crucial for supporting the use of H11.43.