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ICD-10 Guide
ICD-10 CodesH11.01

H11.01

Non-billable

Amyloid pterygium

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

Code Description

ICD-10 H11.01 is a used to indicate a diagnosis of amyloid pterygium.

Key Diagnostic Point:

Amyloid pterygium is a rare ocular condition characterized by the deposition of amyloid protein in the conjunctiva, leading to the formation of a yellowish-white, gelatinous mass. This condition primarily affects the conjunctival tissue but can also involve the sclera and cornea, resulting in visual disturbances and discomfort. The disease progression is typically slow, with patients often presenting with asymptomatic lesions that may eventually cause irritation or cosmetic concerns. Diagnosis is primarily clinical, supported by histopathological examination of biopsy specimens showing amyloid deposits. Differential diagnoses include conjunctival cysts, pinguecula, and other conjunctival tumors. Regular monitoring is essential, as amyloid pterygium can sometimes be associated with systemic amyloidosis, necessitating a thorough evaluation of the patient's overall health status.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires histological confirmation for accurate diagnosis.
  • Treatment complexity: Management may involve surgical excision, which requires careful consideration of the patient's overall health.
  • Documentation requirements: Detailed clinical notes and pathology reports are necessary to support the diagnosis.
  • Coding specificity: Requires precise coding to differentiate from other conjunctival disorders.

Audit Risk Factors

  • Common coding errors: Misclassification with other conjunctival lesions.
  • Documentation gaps: Incomplete clinical notes or lack of pathology reports.
  • Billing challenges: Potential denials if the diagnosis is not well-supported by documentation.

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

Pathology

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

Amyloid pterygium, while rare, can significantly impact patients' quality of life due to visual disturbances and cosmetic concerns. Understanding its clinical significance is essential for early diagnosis and management. Population health impact is limited due to its rarity, but awareness among healthcare providers can improve detection and treatment outcomes. Quality measures should focus on timely diagnosis and appropriate referral for surgical intervention when necessary, contributing to better healthcare utilization patterns.

ICD-9 vs ICD-10

Amyloid pterygium, while rare, can significantly impact patients' quality of life due to visual disturbances and cosmetic concerns. Understanding its clinical significance is essential for early diagnosis and management. Population health impact is limited due to its rarity, but awareness among healthcare providers can improve detection and treatment outcomes. Quality measures should focus on timely diagnosis and appropriate referral for surgical intervention when necessary, contributing to better healthcare utilization patterns.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the case and the procedures performed. Common denials may arise from insufficient documentation or misclassification of the condition. It is advisable to follow coding best practices, including using the most specific codes available and ensuring that all services rendered are clearly linked to the diagnosis.

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 H11.01?

H11.01 specifically covers amyloid pterygium, which is characterized by amyloid deposits in the conjunctiva. It is important to differentiate this from other conjunctival lesions such as pterygium, conjunctival cysts, and tumors.

When should H11.01 be used instead of related codes?

H11.01 should be used when there is a confirmed diagnosis of amyloid pterygium, particularly when histological evidence of amyloid deposits is available. It is crucial to avoid using this code for other types of pterygium or conjunctival lesions without amyloid involvement.

What documentation supports H11.01?

Documentation for H11.01 should include a detailed clinical examination, patient history, and histopathological reports confirming the presence of amyloid deposits in the conjunctiva. Photographic evidence may also be beneficial.