Corneal ulcer
ICD-10 H16.0 is a used to indicate a diagnosis of corneal ulcer.
Corneal ulcer (H16.0) is a localized inflammation of the cornea characterized by the presence of an epithelial defect and associated with infiltration of inflammatory cells. Clinically, patients may present with symptoms such as ocular pain, redness, photophobia, tearing, and decreased vision. The cornea, a transparent front layer of the eye, is crucial for vision and is composed of five layers: epithelium, Bowman's layer, stroma, Descemet's membrane, and endothelium. Corneal ulcers can arise from various etiologies, including infectious agents (bacterial, viral, fungal), trauma, exposure keratitis, or underlying systemic diseases. Disease progression can lead to complications such as corneal scarring, perforation, and potential vision loss if not treated promptly. Diagnostic considerations include a thorough history, slit-lamp examination, and possibly corneal scraping or cultures to identify infectious agents. Timely intervention is critical to prevent severe outcomes, making accurate diagnosis and coding essential for effective patient management.
Standard ICD-10-CM documentation requirements apply
Various clinical presentations within this specialty area
Follow specialty-specific billing guidelines
Standard ICD-10-CM documentation requirements apply
Various clinical presentations within this specialty area
Follow specialty-specific billing guidelines
H16.0 specifically covers corneal ulcers that may be caused by infections, trauma, or other factors leading to epithelial defects in the cornea. It does not include ulcers caused by systemic diseases or other ocular conditions.
H16.0 should be used when there is a confirmed diagnosis of a corneal ulcer, characterized by an epithelial defect and inflammation. It should not be used for corneal abrasions or other corneal disorders without ulceration.
Documentation should include a detailed clinical examination, findings from slit-lamp evaluation, any laboratory results (cultures), and treatment plans. Notes should clearly indicate the diagnosis of a corneal ulcer and the rationale for treatment.
