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ICD-10 Guide
ICD-10 CodesH11.432

H11.432

Billable

Conjunctival hyperemia, left eye

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

Code Description

ICD-10 H11.432 is a billable code used to indicate a diagnosis of conjunctival hyperemia, left eye.

Key Diagnostic Point:

Conjunctival hyperemia in the left eye is characterized by an increased blood flow to the conjunctival vessels, resulting in redness of the eye. This condition can be a response to various irritants, including allergens, infections, or environmental factors. The conjunctiva, a thin membrane covering the sclera and lining the eyelids, becomes inflamed, leading to symptoms such as discomfort, tearing, and visual disturbances. The sclera, cornea, and anterior segment may also be involved, as conjunctival hyperemia can indicate underlying conditions such as conjunctivitis, keratitis, or uveitis. Disease progression may vary; acute cases often resolve with appropriate treatment, while chronic hyperemia may indicate persistent irritation or systemic conditions. Diagnostic considerations include a thorough patient history, physical examination, and possibly additional tests such as slit-lamp examination to assess the extent of involvement and rule out other ocular pathologies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires differentiation from other causes of eye redness.
  • Treatment complexity: Moderate, depending on the underlying cause.
  • Documentation requirements: Requires detailed clinical notes to support the diagnosis.
  • Coding specificity: Specific to left eye involvement, necessitating precise coding.

Audit Risk Factors

  • Common coding errors: Misidentifying the eye involved or using a non-specific code.
  • Documentation gaps: Incomplete patient history or lack of examination details.
  • Billing challenges: Potential denials due to insufficient documentation or incorrect coding.

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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Documentation Requirements

CPT Code

Clinical Scenario

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CPT Code

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Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Conjunctival hyperemia can significantly affect patient quality of life, leading to discomfort and visual disturbances. Understanding its prevalence and causes is essential for population health management. Effective diagnosis and treatment can reduce healthcare utilization patterns, as timely intervention may prevent complications. Epidemiologically, conjunctival hyperemia is common in various demographics, particularly among those exposed to allergens or irritants, highlighting the need for awareness and preventive measures.

ICD-9 vs ICD-10

Conjunctival hyperemia can significantly affect patient quality of life, leading to discomfort and visual disturbances. Understanding its prevalence and causes is essential for population health management. Effective diagnosis and treatment can reduce healthcare utilization patterns, as timely intervention may prevent complications. Epidemiologically, conjunctival hyperemia is common in various demographics, particularly among those exposed to allergens or irritants, highlighting the need for awareness and preventive measures.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for eye examinations and treatments. Common denials may arise from insufficient documentation or failure to provide a clear rationale for the diagnosis. Best practices include thorough documentation of the patient's symptoms, examination findings, and any treatments provided, ensuring that all coding aligns with the clinical documentation.

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 H11.432?

H11.432 covers conjunctival hyperemia specifically in the left eye, which may be due to allergic conjunctivitis, viral or bacterial infections, or environmental irritants. It is essential to differentiate it from other conditions that may cause redness, such as scleritis or episcleritis.

When should H11.432 be used instead of related codes?

H11.432 should be used when the clinical presentation specifically indicates conjunctival hyperemia in the left eye, as opposed to other codes that may pertain to the right eye or bilateral involvement.

What documentation supports H11.432?

Documentation should include a detailed examination of the eye, noting the presence of redness, any associated symptoms, and the results of any diagnostic tests performed. A clear history of the onset and duration of symptoms is also critical.