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ICD-10 Guide
ICD-10 CodesH11.813

H11.813

Billable

Pseudopterygium of conjunctiva, bilateral

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

Code Description

ICD-10 H11.813 is a billable code used to indicate a diagnosis of pseudopterygium of conjunctiva, bilateral.

Key Diagnostic Point:

Pseudopterygium of conjunctiva, bilateral, is characterized by the presence of a triangular fold of conjunctival tissue that extends onto the cornea, resembling a pterygium but lacking the underlying fibrovascular tissue. This condition typically arises as a result of chronic irritation or inflammation of the conjunctiva, often due to environmental factors such as UV exposure, dry eye syndrome, or ocular surface disease. Clinically, patients may present with symptoms such as redness, irritation, and visual disturbances, particularly if the pseudopterygium encroaches on the visual axis. The anatomy involved includes the conjunctiva, cornea, and potentially the sclera, as the abnormal tissue may affect adjacent structures. Disease progression can lead to increased discomfort and cosmetic concerns, and in some cases, surgical intervention may be required to alleviate symptoms or restore vision. Diagnostic considerations include a thorough ocular examination, assessment of symptoms, and possibly imaging studies to rule out other conjunctival or corneal pathologies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from true pterygium and other conjunctival lesions.
  • Treatment complexity: May necessitate surgical intervention if symptomatic.
  • Documentation requirements: Detailed clinical notes and symptom descriptions are essential.
  • Coding specificity: Requires precise coding to differentiate from similar conditions.

Audit Risk Factors

  • Common coding errors: Misclassification as true pterygium or other conjunctival disorders.
  • Documentation gaps: Lack of detailed symptomatology or clinical findings.
  • Billing challenges: Potential for denials if documentation does not support 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

Optometry

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

The clinical significance of H11.813 lies in its potential to affect visual acuity and patient quality of life due to discomfort and cosmetic concerns. In terms of population health, pseudopterygium can contribute to increased healthcare utilization, particularly in populations exposed to environmental irritants. Quality measures may include monitoring patient outcomes following surgical interventions and ensuring appropriate follow-up care to prevent recurrence.

ICD-9 vs ICD-10

The clinical significance of H11.813 lies in its potential to affect visual acuity and patient quality of life due to discomfort and cosmetic concerns. In terms of population health, pseudopterygium can contribute to increased healthcare utilization, particularly in populations exposed to environmental irritants. Quality measures may include monitoring patient outcomes following surgical interventions and ensuring appropriate follow-up care to prevent recurrence.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly supported by the medical record, as well as any associated procedures performed. Common denials may arise from insufficient documentation or misclassification of the condition. Best practices include maintaining thorough clinical notes, using appropriate modifiers for surgical procedures, and ensuring that all coding aligns with the documented clinical scenario.

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 H11.813?

H11.813 specifically covers bilateral pseudopterygium of the conjunctiva, which is characterized by a triangular fold of conjunctival tissue extending onto the cornea, without the underlying fibrovascular tissue seen in true pterygium.

When should H11.813 be used instead of related codes?

H11.813 should be used when the condition is bilateral and presents as pseudopterygium. It is important to differentiate it from unilateral cases (H11.812) and true pterygium (H11.1) based on clinical findings.

What documentation supports H11.813?

Documentation should include a comprehensive ocular examination, detailed descriptions of symptoms, and clinical findings that confirm the diagnosis of bilateral pseudopterygium, including any relevant imaging studies.