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ICD-10 Guide
ICD-10 CodesH16.11

H16.11

Non-billable

Macular keratitis

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

Code Description

ICD-10 H16.11 is a used to indicate a diagnosis of macular keratitis.

Key Diagnostic Point:

Macular keratitis, classified under H16.11, refers to inflammation of the cornea characterized by the presence of a macular lesion. This condition primarily affects the corneal epithelium and stroma, leading to symptoms such as redness, pain, photophobia, and blurred vision. The macular lesion is typically a grayish-white area on the cornea, which may be associated with underlying infectious or non-infectious etiologies. The anatomy involved includes the cornea, which is the transparent front part of the eye, and its interaction with the conjunctiva and sclera. Disease progression can vary; if untreated, macular keratitis may lead to corneal scarring or vision loss. Diagnostic considerations include a thorough eye examination, slit-lamp evaluation, and possibly corneal scraping or cultures to identify infectious agents. Clinicians must differentiate macular keratitis from other corneal disorders, such as keratoconus or corneal ulcers, to ensure appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differential diagnosis to rule out other corneal conditions.
  • Treatment complexity: May involve topical antibiotics, corticosteroids, or referral to specialists.
  • Documentation requirements: Detailed clinical notes are necessary to support diagnosis and treatment.
  • Coding specificity: Requires accurate coding to reflect the specific type of keratitis.

Audit Risk Factors

  • Common coding errors: Misclassification with other types of keratitis.
  • Documentation gaps: Incomplete clinical notes may lead to denials.
  • Billing challenges: Ensuring that the diagnosis aligns with the treatment provided.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Macular keratitis can significantly impact patient quality of life due to its effects on vision. Understanding its epidemiology is crucial, as it can arise from various infectious agents, making it a public health concern. Effective management and coding of this condition contribute to improved healthcare utilization patterns and quality measures, ultimately enhancing patient outcomes.

ICD-9 vs ICD-10

Macular keratitis can significantly impact patient quality of life due to its effects on vision. Understanding its epidemiology is crucial, as it can arise from various infectious agents, making it a public health concern. Effective management and coding of this condition contribute to improved healthcare utilization patterns and quality measures, ultimately enhancing patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include verifying patient eligibility and ensuring that the services rendered align with the diagnosis. Common denials may arise from insufficient documentation or coding errors, so adherence to coding best practices is essential. It is advisable to use modifiers when necessary to clarify the service 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 H16.11?

H16.11 specifically covers macular keratitis, which may arise from various causes including viral infections (e.g., herpes simplex), bacterial infections, or inflammatory processes. It is characterized by a macular lesion on the cornea.

When should H16.11 be used instead of related codes?

H16.11 should be used when the clinical presentation includes a macular lesion on the cornea, differentiating it from other keratitis codes that do not specify the lesion type or location.

What documentation supports H16.11?

Documentation should include a detailed clinical examination, description of the corneal lesion, any diagnostic tests performed, and the treatment plan. This ensures that the diagnosis is substantiated and aligns with coding guidelines.