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ICD-10 Guide
ICD-10 CodesH11.449

H11.449

Billable

Conjunctival cysts, unspecified eye

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

Code Description

ICD-10 H11.449 is a billable code used to indicate a diagnosis of conjunctival cysts, unspecified eye.

Key Diagnostic Point:

Conjunctival cysts, also known as conjunctival retention cysts, are benign lesions that occur on the conjunctiva, the clear membrane covering the white part of the eye and the inner eyelids. These cysts can vary in size and may be filled with clear fluid or mucus. Clinically, they often present as painless, translucent nodules that can be mistaken for other conjunctival lesions. The anatomy involved includes the conjunctiva, which is rich in goblet cells that produce mucus; when these glands become obstructed, cyst formation can occur. Disease progression is typically benign, with many cysts remaining asymptomatic and requiring no treatment. However, larger cysts may cause discomfort or visual disturbances and may necessitate surgical intervention. Diagnostic considerations include a thorough ocular examination, and in some cases, imaging may be warranted to differentiate conjunctival cysts from other lesions such as conjunctival tumors or pterygium. A careful history and physical examination are crucial for accurate diagnosis.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low, as conjunctival cysts are typically straightforward to diagnose.
  • Treatment complexity: Low, as many cases are self-limiting and require minimal intervention.
  • Documentation requirements: Moderate, requiring clear descriptions of the lesion and any symptoms.
  • Coding specificity: Moderate, as it is important to specify the eye affected.

Audit Risk Factors

  • Common coding errors: Misidentifying the cyst as a more serious condition.
  • Documentation gaps: Lack of detailed descriptions of the cyst's characteristics.
  • Billing challenges: Potential denials if the medical necessity for treatment is not clearly documented.

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 their prevalence and management is crucial for ophthalmologists and primary care providers. Effective management of conjunctival cysts can reduce unnecessary healthcare utilization and improve patient outcomes. Awareness of these lesions contributes to better population health strategies, as timely diagnosis and treatment can prevent complications.

ICD-9 vs ICD-10

Conjunctival cysts, while generally benign, can impact patient quality of life if they cause discomfort or visual obstruction. Understanding their prevalence and management is crucial for ophthalmologists and primary care providers. Effective management of conjunctival cysts can reduce unnecessary healthcare utilization and improve patient outcomes. Awareness of these lesions contributes to better population health strategies, as timely diagnosis and treatment can prevent complications.

Reimbursement & Billing Impact

Reimbursement considerations include verifying that the procedure performed is medically necessary and that the documentation reflects the patient's symptoms and the cyst's characteristics. Common denials may arise if the documentation does not sufficiently justify the need for surgical intervention or if the coding does not align with the services rendered. Best practices include thorough documentation of the clinical findings and any treatments provided, ensuring that all coding aligns with the latest ICD-10 guidelines.

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 H11.449?

H11.449 covers unspecified conjunctival cysts that do not have a specific laterality indicated. This includes retention cysts that may arise from obstructed glands in the conjunctiva.

When should H11.449 be used instead of related codes?

H11.449 should be used when the conjunctival cyst is not specified as being on the right or left eye, or when the specific type of cyst is not documented.

What documentation supports H11.449?

Documentation should include a detailed description of the cyst, its size, location, any associated symptoms, and the results of any diagnostic tests performed.