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ICD-10 Guide
ICD-10 CodesH11.819

H11.819

Billable

Pseudopterygium of conjunctiva, unspecified eye

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

Code Description

ICD-10 H11.819 is a billable code used to indicate a diagnosis of pseudopterygium of conjunctiva, unspecified eye.

Key Diagnostic Point:

Pseudopterygium of conjunctiva is a condition characterized by a fibrovascular membrane that extends from the conjunctiva onto the cornea, resembling a pterygium but without the typical associated features. This condition can occur in either eye and is often associated with chronic irritation or inflammation of the conjunctiva. Clinically, patients may present with symptoms such as redness, irritation, and visual disturbances, particularly if the pseudopterygium encroaches upon the visual axis. The anatomy involved includes the conjunctiva, which is the mucous membrane covering the front of the eye and the inner surface of the eyelids, as well as the cornea and sclera. Disease progression can vary; while some cases remain stable, others may lead to significant visual impairment if left untreated. Diagnostic considerations include a thorough ocular examination, slit-lamp evaluation, and possibly imaging studies to assess the extent of the conjunctival involvement. Differentiating pseudopterygium from true pterygium is crucial for appropriate management and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other conjunctival disorders.
  • Treatment complexity: May involve surgical intervention if vision is affected.
  • Documentation requirements: Detailed clinical notes needed to support diagnosis.
  • Coding specificity: Requires precise coding to avoid misclassification.

Audit Risk Factors

  • Common coding errors: Misclassification with pterygium or other conjunctival disorders.
  • Documentation gaps: Incomplete clinical notes may lead to denials.
  • Billing challenges: Potential for denials if the condition is not well-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

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

Pseudopterygium can significantly affect a patient's quality of life due to discomfort and potential visual impairment. Understanding its prevalence and impact on population health is crucial for healthcare providers. Effective management can lead to improved patient outcomes and reduced healthcare utilization. Epidemiologically, conditions like pseudopterygium may be more prevalent in populations exposed to chronic environmental irritants, highlighting the need for preventive measures and awareness in at-risk groups.

ICD-9 vs ICD-10

Pseudopterygium can significantly affect a patient's quality of life due to discomfort and potential visual impairment. Understanding its prevalence and impact on population health is crucial for healthcare providers. Effective management can lead to improved patient outcomes and reduced healthcare utilization. Epidemiologically, conditions like pseudopterygium may be more prevalent in populations exposed to chronic environmental irritants, highlighting the need for preventive measures and awareness in at-risk groups.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the condition is well-documented and that any procedures performed are appropriately coded. Common denials may arise from insufficient documentation or failure to provide evidence of medical necessity. Best practices include maintaining clear and comprehensive clinical notes, ensuring that all relevant symptoms and findings are recorded, and using appropriate modifiers when necessary to indicate the nature of the treatment provided.

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 H11.819?

H11.819 specifically covers pseudopterygium of the conjunctiva, which is a non-invasive growth that resembles a pterygium but does not invade the cornea. It is important to differentiate it from other conjunctival disorders such as true pterygium or conjunctival cysts.

When should H11.819 be used instead of related codes?

H11.819 should be used when the condition is specifically diagnosed as pseudopterygium without any associated features of pterygium. If the growth is invasive or has other characteristics, related codes such as H11.81 should be considered.

What documentation supports H11.819?

Documentation should include a detailed clinical examination, description of symptoms, and findings from slit-lamp examination. Any imaging studies or referrals to specialists should also be included to support the diagnosis.