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ICD-10 Guide
ICD-10 CodesH16.06

H16.06

Non-billable

Mycotic corneal ulcer

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

Code Description

ICD-10 H16.06 is a used to indicate a diagnosis of mycotic corneal ulcer.

Key Diagnostic Point:

Mycotic corneal ulcer, classified under H16.06, is a severe ocular condition characterized by the presence of fungal infection in the cornea, leading to ulceration. Clinically, patients may present with symptoms such as redness, pain, photophobia, tearing, and decreased vision. The cornea, a transparent front part of the eye, is crucial for light refraction and protection. Mycotic infections can arise from various fungi, including Aspergillus and Candida species, often following trauma or pre-existing ocular surface disease. Disease progression can lead to corneal scarring, perforation, and potential loss of vision if not treated promptly. Diagnostic considerations include a thorough eye examination, corneal scraping for culture, and possibly imaging studies to assess the extent of the infection. Early identification and intervention are critical to prevent complications and preserve vision.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires specific laboratory tests and clinical evaluation.
  • Treatment complexity: May involve antifungal medications, surgical intervention, and follow-up care.
  • Documentation requirements: Detailed clinical notes and diagnostic results are essential.
  • Coding specificity: Requires precise coding to differentiate from other corneal conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with bacterial or viral ulcers.
  • Documentation gaps: Incomplete clinical notes regarding the causative organism.
  • Billing challenges: Potential denials due to lack of supporting documentation for antifungal treatments.

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

Infectious Disease

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

Mycotic corneal ulcers can significantly impact population health, particularly in regions with high rates of fungal infections. They contribute to increased healthcare utilization due to the need for specialized treatment and potential surgical interventions. Quality measures focus on timely diagnosis and effective management to prevent vision loss. Epidemiologically, these conditions highlight the importance of awareness and preventive strategies in at-risk populations, such as contact lens users and individuals with compromised immune systems.

ICD-9 vs ICD-10

Mycotic corneal ulcers can significantly impact population health, particularly in regions with high rates of fungal infections. They contribute to increased healthcare utilization due to the need for specialized treatment and potential surgical interventions. Quality measures focus on timely diagnosis and effective management to prevent vision loss. Epidemiologically, these conditions highlight the importance of awareness and preventive strategies in at-risk populations, such as contact lens users and individuals with compromised immune systems.

Reimbursement & Billing Impact

Reimbursement considerations include the use of antifungal medications, which may require prior authorization. Common denials can occur if the documentation does not clearly establish the fungal nature of the ulcer or if treatment protocols are not followed. Best practices include maintaining thorough clinical notes, ensuring all diagnostic tests are documented, and confirming that the coding aligns with the services provided.

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 H16.06?

H16.06 specifically covers mycotic corneal ulcers caused by fungal infections, which may include conditions like fungal keratitis resulting from trauma or contact lens use.

When should H16.06 be used instead of related codes?

H16.06 should be used when a corneal ulcer is confirmed to be of fungal origin, differentiating it from bacterial or viral ulcers, which are coded under H16.05 and H16.04 respectively.

What documentation supports H16.06?

Documentation should include clinical findings, results from corneal scraping cultures, treatment plans, and follow-up assessments to substantiate the diagnosis of a mycotic corneal ulcer.