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ICD-10 Guide
ICD-10 CodesH11.89

H11.89

Billable

Other specified disorders of conjunctiva

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

Code Description

ICD-10 H11.89 is a billable code used to indicate a diagnosis of other specified disorders of conjunctiva.

Key Diagnostic Point:

H11.89 refers to other specified disorders of the conjunctiva, which encompasses a variety of conditions affecting the conjunctival tissue, the thin membrane covering the white part of the eye and the inner surface of the eyelids. Clinical presentations may include conjunctival hyperemia, swelling, or the presence of lesions, which can result from infections, allergies, or environmental irritants. The conjunctiva is crucial for maintaining ocular surface health, and disorders can lead to significant discomfort and visual disturbances. Disease progression may vary; acute conditions like conjunctivitis can resolve with appropriate treatment, while chronic disorders may require ongoing management. Diagnostic considerations include a thorough history and physical examination, slit-lamp examination, and possibly conjunctival biopsy to rule out neoplastic processes. Understanding the underlying etiology is essential for effective treatment and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other ocular conditions.
  • Treatment complexity: May involve topical medications, surgical interventions, or referral to specialists.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis.
  • Coding specificity: Requires precise coding to capture the specific disorder.

Audit Risk Factors

  • Common coding errors: Misclassification of conjunctival disorders.
  • Documentation gaps: Insufficient detail in clinical notes.
  • Billing challenges: Potential denials due to lack of specificity.

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

Allergy and Immunology

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of H11.89 lies in its potential to affect visual health and quality of life. Conjunctival disorders can lead to discomfort, visual impairment, and increased healthcare utilization due to recurrent symptoms. Understanding the epidemiology of these conditions helps in developing targeted public health interventions and quality measures aimed at improving ocular health outcomes in the population.

ICD-9 vs ICD-10

The clinical significance of H11.89 lies in its potential to affect visual health and quality of life. Conjunctival disorders can lead to discomfort, visual impairment, and increased healthcare utilization due to recurrent symptoms. Understanding the epidemiology of these conditions helps in developing targeted public health interventions and quality measures aimed at improving ocular health outcomes in the population.

Reimbursement & Billing Impact

Reimbursement may vary based on the complexity of the condition and the interventions performed. Common denials can occur if the documentation does not clearly justify the diagnosis or if the services rendered are not adequately described. Coders should ensure that all relevant clinical details are included in the medical record to minimize audit risks and ensure appropriate reimbursement.

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 H11.89?

H11.89 covers various conjunctival disorders not classified elsewhere, including conjunctival cysts, pingueculae, and specific allergic reactions affecting the conjunctiva. Each condition has distinct diagnostic criteria based on clinical presentation and examination findings.

When should H11.89 be used instead of related codes?

H11.89 should be used when the conjunctival disorder is specified but does not fit into more common categories like conjunctivitis or pterygium. It is essential to document the specific nature of the disorder to justify the use of this code.

What documentation supports H11.89?

Documentation should include a detailed history of the patient's symptoms, findings from the ocular examination, any diagnostic tests performed, and the rationale for the diagnosis. This may also include treatment plans and follow-up notes.