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ICD-10 Guide
ICD-10 CodesH16.079

H16.079

Billable

Perforated corneal ulcer, unspecified eye

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

Code Description

ICD-10 H16.079 is a billable code used to indicate a diagnosis of perforated corneal ulcer, unspecified eye.

Key Diagnostic Point:

A perforated corneal ulcer is a serious ocular condition characterized by the presence of a defect in the corneal epithelium and stroma that extends through to the anterior chamber of the eye, leading to potential vision loss and intraocular infection. The cornea, which is the transparent front part of the eye, plays a crucial role in focusing light. When an ulcer perforates, it can result in the leakage of aqueous humor and exposure of intraocular structures, increasing the risk of endophthalmitis. Clinical presentation may include severe pain, redness, photophobia, and decreased visual acuity. The condition can arise from various etiologies, including infectious agents (bacterial, viral, fungal), chemical burns, or trauma. Diagnosis typically involves a comprehensive eye examination, including slit-lamp evaluation and possibly corneal cultures. Timely intervention is critical to prevent complications such as scarring or loss of the eye. Treatment may involve topical antibiotics, surgical repair, or corneal transplantation, depending on the severity and underlying cause of the ulcer.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassifying the type of corneal ulcer.
  • Documentation gaps may arise if the severity and cause of the ulcer are not clearly stated.
  • Billing challenges can occur if the treatment plan is not adequately documented.

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

Emergency Medicine

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 H16.079 lies in its potential to lead to severe complications, including vision loss and increased healthcare utilization due to emergency interventions. Understanding the epidemiology of corneal ulcers, particularly in at-risk populations, is crucial for preventive measures and quality care. Monitoring quality measures related to corneal health can help improve outcomes and reduce the incidence of perforated ulcers.

ICD-9 vs ICD-10

The clinical significance of H16.079 lies in its potential to lead to severe complications, including vision loss and increased healthcare utilization due to emergency interventions. Understanding the epidemiology of corneal ulcers, particularly in at-risk populations, is crucial for preventive measures and quality care. Monitoring quality measures related to corneal health can help improve outcomes and reduce the incidence of perforated ulcers.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of the treatment provided. Common denials may arise from insufficient documentation of the perforation or the underlying cause of the ulcer. Coders should ensure that all relevant clinical information is included in the medical record to support the use of this code and to justify the medical necessity of the procedures performed.

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 H16.079?

H16.079 covers perforated corneal ulcers of unspecified eye, which may result from infections, trauma, or other corneal diseases. It is essential to differentiate it from non-perforated ulcers and specify the cause when possible.

When should H16.079 be used instead of related codes?

H16.079 should be used when the corneal ulcer is confirmed to be perforated and the specific eye is not identified. If the eye is specified or if the ulcer is non-perforated, other codes should be considered.

What documentation supports H16.079?

Documentation should include a detailed clinical examination, imaging results, treatment plans, and any relevant history of trauma or infection. Clear notes on the perforation and its implications for treatment are essential.