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ICD-10 Guide
ICD-10 CodesH11.433

H11.433

Billable

Conjunctival hyperemia, bilateral

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

Code Description

ICD-10 H11.433 is a billable code used to indicate a diagnosis of conjunctival hyperemia, bilateral.

Key Diagnostic Point:

Conjunctival hyperemia, bilateral, is characterized by the dilation of conjunctival blood vessels, leading to a red or inflamed appearance of the conjunctiva in both eyes. This condition can be caused by various factors, including allergic reactions, infections, environmental irritants, or systemic diseases. The conjunctiva is a thin, transparent membrane that covers the white part of the eyeball and lines the inside of the eyelids, playing a crucial role in protecting the eye and maintaining moisture. In cases of bilateral conjunctival hyperemia, both eyes exhibit similar symptoms, which can include redness, itching, and discharge. The disease progression may vary depending on the underlying cause; for instance, allergic conjunctivitis may resolve with the removal of allergens, while infectious causes may require antibiotic treatment. Diagnostic considerations involve a thorough patient history, physical examination, and possibly laboratory tests to identify the underlying etiology. Understanding the anatomy involved, including the conjunctiva, sclera, and cornea, is essential for accurate diagnosis and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires differentiation from other ocular conditions.
  • Treatment complexity: Varies based on underlying cause; may involve topical medications or systemic therapies.
  • Documentation requirements: Requires detailed patient history and examination findings.
  • Coding specificity: Specific to bilateral conjunctival hyperemia; related codes may not capture bilateral involvement.

Audit Risk Factors

  • Common coding errors: Misclassification as unilateral or incorrect underlying cause.
  • Documentation gaps: Incomplete patient history or lack of examination details.
  • Billing challenges: Potential denials if documentation does not clearly support bilateral involvement.

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

Bilateral conjunctival hyperemia can significantly impact patient quality of life, leading to discomfort and visual disturbances. It is prevalent in populations exposed to allergens or irritants, contributing to increased healthcare utilization for eye-related complaints. Understanding the epidemiology of this condition can help healthcare providers implement preventive measures and improve patient education on managing symptoms effectively.

ICD-9 vs ICD-10

Bilateral conjunctival hyperemia can significantly impact patient quality of life, leading to discomfort and visual disturbances. It is prevalent in populations exposed to allergens or irritants, contributing to increased healthcare utilization for eye-related complaints. Understanding the epidemiology of this condition can help healthcare providers implement preventive measures and improve patient education on managing symptoms effectively.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the underlying cause and treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Coders should ensure that all relevant symptoms and examination findings are clearly documented to support the diagnosis and justify the services billed. Familiarity with payer-specific guidelines can also aid in minimizing billing challenges.

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 H11.433?

H11.433 covers bilateral conjunctival hyperemia due to various causes such as allergic conjunctivitis, viral or bacterial infections, and environmental irritants. It is essential to identify the underlying cause for appropriate management.

When should H11.433 be used instead of related codes?

H11.433 should be used when both eyes exhibit conjunctival hyperemia. If only one eye is affected, H11.432 should be selected. Accurate documentation of bilateral symptoms is crucial for proper code selection.

What documentation supports H11.433?

Documentation should include a comprehensive eye examination, patient history detailing symptoms, duration, and any potential allergens or irritants, as well as findings from any diagnostic tests performed.