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ICD-10 Guide
ICD-10 CodesH11.821

H11.821

Billable

Conjunctivochalasis, right eye

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

Code Description

ICD-10 H11.821 is a billable code used to indicate a diagnosis of conjunctivochalasis, right eye.

Key Diagnostic Point:

Conjunctivochalasis is a condition characterized by the redundant conjunctival tissue that can lead to ocular discomfort and visual disturbances. It primarily affects the right eye in this coding instance. The conjunctiva, a thin membrane covering the sclera and lining the eyelids, becomes lax, which may result in symptoms such as dryness, irritation, and foreign body sensation. The condition is often associated with aging, chronic inflammation, or previous ocular surgeries. Disease progression can lead to increased tear film instability and may exacerbate other ocular surface disorders, including keratitis or conjunctivitis. Diagnostic considerations include a thorough ocular examination, where the clinician assesses the conjunctival folds and evaluates tear film quality. Slit-lamp examination is crucial for identifying the extent of conjunctivochalasis and ruling out other anterior segment disorders. Treatment options may include artificial tears, surgical intervention, or addressing underlying causes such as meibomian gland dysfunction.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misidentification of the affected eye or confusion with similar conjunctival conditions.
  • Documentation gaps may arise if the clinical rationale for the diagnosis is not clearly articulated.
  • Billing challenges can occur if the treatment provided is not adequately supported by the documentation.

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

Conjunctivochalasis can significantly affect a patient's quality of life by causing discomfort and visual disturbances, leading to increased healthcare utilization. Understanding this condition is essential for improving population health outcomes, as timely diagnosis and treatment can prevent complications associated with ocular surface disorders. Epidemiologically, conjunctivochalasis is more prevalent in older adults, highlighting the need for awareness in geriatric care.

ICD-9 vs ICD-10

Conjunctivochalasis can significantly affect a patient's quality of life by causing discomfort and visual disturbances, leading to increased healthcare utilization. Understanding this condition is essential for improving population health outcomes, as timely diagnosis and treatment can prevent complications associated with ocular surface disorders. Epidemiologically, conjunctivochalasis is more prevalent in older adults, highlighting the need for awareness in geriatric care.

Reimbursement & Billing Impact

Reimbursement considerations include verifying that the treatment aligns with the diagnosis and that any procedures performed are appropriately coded. Common denials may arise from insufficient documentation or lack of medical necessity. Best practices include maintaining thorough clinical notes and ensuring that all services rendered are justified by the patient's clinical presentation.

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 H11.821?

H11.821 specifically covers conjunctivochalasis of the right eye, a condition where excess conjunctival tissue causes discomfort and potential visual disturbances. It is important to differentiate it from other conjunctival disorders such as conjunctivitis or pterygium.

When should H11.821 be used instead of related codes?

H11.821 should be used when the patient presents with specific symptoms of conjunctivochalasis in the right eye, and other conditions affecting the conjunctiva have been ruled out. It is essential to document the clinical findings that support this diagnosis.

What documentation supports H11.821?

Documentation should include a detailed ocular examination report, noting the presence of conjunctival redundancy, associated symptoms, and any relevant history of ocular surgeries or conditions. Photographic evidence may also support the diagnosis.