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ICD-10 Guide
ICD-10 CodesH16.05

H16.05

Non-billable

Mooren's corneal ulcer

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

Code Description

ICD-10 H16.05 is a used to indicate a diagnosis of mooren's corneal ulcer.

Key Diagnostic Point:

Mooren's corneal ulcer is a progressive, painful condition characterized by the development of a unilateral or bilateral corneal ulceration that is typically associated with inflammation. The cornea, a transparent layer at the front of the eye, is crucial for vision and is composed of several layers, including the epithelium, stroma, and endothelium. In Mooren's ulcer, the immune-mediated destruction of the corneal tissue occurs, leading to the formation of a painful, often recurrent ulcer that can result in scarring and vision loss if untreated. The condition is most commonly seen in middle-aged individuals and may be associated with systemic diseases such as hepatitis or autoimmune disorders. Diagnosis is primarily clinical, supported by slit-lamp examination revealing characteristic features of the ulcer. Differential diagnoses include other causes of corneal ulcers such as infectious keratitis or neurotrophic ulcers. Prompt diagnosis and management are essential to prevent complications such as perforation or severe visual impairment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other corneal conditions.
  • Treatment complexity: May involve topical medications, surgical interventions, or referral to specialists.
  • Documentation requirements: Detailed clinical notes and treatment plans are necessary.
  • Coding specificity: Requires precise coding to capture the specific nature of the ulcer.

Audit Risk Factors

  • Common coding errors: Misclassification of the ulcer type.
  • Documentation gaps: Incomplete clinical notes regarding the ulcer's characteristics.
  • Billing challenges: Potential denials due to lack of supporting documentation for the diagnosis.

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

Mooren's corneal ulcer has significant clinical implications, as it can lead to vision impairment and decreased quality of life for affected individuals. The condition may contribute to increased healthcare utilization due to the need for specialist consultations, surgical interventions, and ongoing management. Understanding the epidemiology of Mooren's ulcer is essential for public health, as it may be more prevalent in certain populations or associated with systemic diseases, highlighting the need for awareness and timely intervention.

ICD-9 vs ICD-10

Mooren's corneal ulcer has significant clinical implications, as it can lead to vision impairment and decreased quality of life for affected individuals. The condition may contribute to increased healthcare utilization due to the need for specialist consultations, surgical interventions, and ongoing management. Understanding the epidemiology of Mooren's ulcer is essential for public health, as it may be more prevalent in certain populations or associated with systemic diseases, highlighting the need for awareness and timely intervention.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case and the necessity for follow-up visits. Common denials may arise from insufficient documentation or lack of clarity regarding the diagnosis. It is crucial to ensure that all relevant clinical notes, treatment plans, and any referrals to specialists are included in the patient's medical record to support the billing process. Adhering to coding best practices, such as using the most specific code available, can help mitigate billing challenges.

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 H16.05?

H16.05 specifically covers Mooren's corneal ulcer, which is characterized by painful, progressive corneal ulceration that is often idiopathic and may be associated with systemic conditions.

When should H16.05 be used instead of related codes?

H16.05 should be used when the diagnosis is confirmed as Mooren's ulcer, particularly when the ulcer is idiopathic and not due to infectious or traumatic causes.

What documentation supports H16.05?

Documentation should include a detailed clinical examination, slit-lamp findings, treatment plans, and any relevant systemic evaluations to support the diagnosis of Mooren's corneal ulcer.