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ICD-10 Guide
ICD-10 CodesH16.042

H16.042

Billable

Marginal corneal ulcer, left eye

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

Code Description

ICD-10 H16.042 is a billable code used to indicate a diagnosis of marginal corneal ulcer, left eye.

Key Diagnostic Point:

Marginal corneal ulcer of the left eye is characterized by localized inflammation and ulceration at the edge of the cornea, often resulting from infectious or non-infectious causes. Clinically, patients may present with symptoms such as redness, pain, photophobia, and decreased vision. The anatomy involved includes the cornea, which is the transparent front part of the eye, and its marginal zone where the cornea meets the sclera. Disease progression can lead to complications such as corneal scarring or perforation if left untreated. Diagnostic considerations include a thorough eye examination, slit-lamp biomicroscopy, and possibly cultures or staining to identify infectious agents. The condition may be associated with underlying systemic diseases, contact lens wear, or environmental factors, necessitating a comprehensive evaluation to determine the etiology and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other corneal conditions such as keratitis or other types of ulcers.
  • Treatment complexity: May involve topical antibiotics, corticosteroids, or surgical intervention depending on severity.
  • Documentation requirements: Detailed clinical notes and diagnostic tests are essential for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other corneal disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the eye involved or failure to document the cause.
  • Documentation gaps: Incomplete clinical notes regarding symptoms or treatment plans.
  • Billing challenges: Potential denials due to lack of supporting documentation or incorrect coding.

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

Primary care

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

Marginal corneal ulcers can significantly impact patient quality of life, leading to pain and visual impairment. Understanding the epidemiology of this condition is crucial, as it may be associated with contact lens use, environmental factors, or systemic diseases. Effective management and coding of H16.042 can improve healthcare utilization patterns and contribute to better population health outcomes by ensuring timely treatment and reducing complications.

ICD-9 vs ICD-10

Marginal corneal ulcers can significantly impact patient quality of life, leading to pain and visual impairment. Understanding the epidemiology of this condition is crucial, as it may be associated with contact lens use, environmental factors, or systemic diseases. Effective management and coding of H16.042 can improve healthcare utilization patterns and contribute to better population health outcomes by ensuring timely treatment and reducing complications.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, and it is essential to ensure that all documentation aligns with the coding. Common denials may occur if the documentation does not clearly support the diagnosis or if the code is not used appropriately. Best practices include maintaining thorough clinical notes and ensuring that all relevant information is captured during the patient encounter.

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 H16.042?

H16.042 specifically covers marginal corneal ulcers of the left eye, which may arise from infectious agents, trauma, or underlying systemic conditions. It is essential to differentiate it from other corneal disorders such as central corneal ulcers or keratitis.

When should H16.042 be used instead of related codes?

H16.042 should be used when the clinical presentation specifically indicates a marginal corneal ulcer in the left eye, distinguishing it from right eye conditions or other types of corneal ulcers.

What documentation supports H16.042?

Documentation should include a detailed clinical examination, patient history, diagnostic test results, and treatment plans. Specific notes on symptoms, visual acuity, and any interventions performed are crucial for supporting the use of this code.