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ICD-10 Guide
ICD-10 CodesH11.442

H11.442

Billable

Conjunctival cysts, left eye

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

Code Description

ICD-10 H11.442 is a billable code used to indicate a diagnosis of conjunctival cysts, left eye.

Key Diagnostic Point:

Conjunctival cysts, specifically in the left eye, are benign lesions that arise from the conjunctiva, the clear membrane covering the white part of the eye and the inner surface of the eyelids. Clinically, these cysts may present as small, translucent, or yellowish bumps on the conjunctiva, often asymptomatic but can cause discomfort or irritation if they become large or inflamed. The anatomy involved includes the conjunctival tissue, which can become obstructed due to various factors, leading to the accumulation of fluid. Disease progression is typically slow, with cysts remaining stable in size; however, they may occasionally rupture or become infected. Diagnostic considerations include a thorough ocular examination, where the clinician assesses the cyst's size, location, and any associated symptoms. Differential diagnoses may include other conjunctival lesions such as papillomas or pterygia, necessitating careful evaluation to ensure accurate diagnosis and management.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low - straightforward clinical presentation
  • Treatment complexity: Low - often requires simple excision if symptomatic
  • Documentation requirements: Low - basic documentation of clinical findings
  • Coding specificity: Medium - specific to conjunctival cysts in the left eye

Audit Risk Factors

  • Common coding errors: Misidentification of cysts as other conjunctival lesions
  • Documentation gaps: Incomplete clinical notes regarding the cyst's characteristics
  • Billing challenges: Potential denials if the cyst is not documented as symptomatic

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Conjunctival cysts, while generally benign, can impact patient quality of life if they cause discomfort or visual obstruction. Understanding the prevalence and management of these cysts contributes to better population health outcomes. Effective coding and documentation practices can enhance healthcare utilization patterns and ensure appropriate resource allocation for ocular health.

ICD-9 vs ICD-10

Conjunctival cysts, while generally benign, can impact patient quality of life if they cause discomfort or visual obstruction. Understanding the prevalence and management of these cysts contributes to better population health outcomes. Effective coding and documentation practices can enhance healthcare utilization patterns and ensure appropriate resource allocation for ocular health.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for ophthalmic procedures. Common denials may arise from lack of documentation supporting the necessity of treatment, especially if the cyst is asymptomatic. Best practices include thorough clinical notes and ensuring that the procedure performed aligns with the diagnosis coded.

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 H11.442?

H11.442 specifically covers conjunctival cysts located in the left eye. These cysts are typically benign and may arise from obstructed conjunctival glands or other benign processes. They are distinct from other conjunctival lesions such as tumors or inflammatory conditions.

When should H11.442 be used instead of related codes?

H11.442 should be used when documenting a conjunctival cyst specifically in the left eye. If the cyst is in the right eye, H11.441 should be used. Accurate laterality is crucial for proper coding.

What documentation supports H11.442?

Documentation should include a detailed description of the cyst's size, location, and any associated symptoms. Clinical notes should also indicate whether the cyst is symptomatic or asymptomatic and any treatment provided.