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ICD-10 Guide
ICD-10 CodesH11.012

H11.012

Billable

Amyloid pterygium of left eye

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

Code Description

ICD-10 H11.012 is a billable code used to indicate a diagnosis of amyloid pterygium of left eye.

Key Diagnostic Point:

Amyloid pterygium of the left eye is a rare ocular condition characterized by the deposition of amyloid protein in the conjunctiva, leading to a yellowish-white, gelatinous appearance on the eye's surface. This condition primarily affects the conjunctiva but can also involve the sclera and cornea, resulting in potential visual disturbances. Clinically, patients may present with asymptomatic lesions or experience irritation and cosmetic concerns. The disease progression is typically slow, and while it is not known to be malignant, it can cause discomfort and may interfere with vision if it encroaches on the cornea. Diagnostic considerations include a thorough ocular examination, and in some cases, a biopsy may be performed to confirm the presence of amyloid deposits. Differential diagnoses include other conjunctival lesions such as conjunctival cysts or papillomas. Early identification and monitoring are essential to manage symptoms and prevent complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires histological confirmation and differentiation from other conjunctival lesions.
  • Treatment complexity: Management may involve surgical excision if symptomatic or visually significant.
  • Documentation requirements: Detailed clinical notes and possibly pathology reports are necessary for accurate coding.
  • Coding specificity: Specific to amyloid pterygium, requiring precise documentation to avoid misclassification.

Audit Risk Factors

  • Common coding errors: Misidentification of the condition or incorrect laterality.
  • Documentation gaps: Incomplete clinical notes or lack of biopsy results.
  • Billing challenges: Potential denials due to insufficient documentation or misclassification.

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 affect patients' quality of life due to cosmetic concerns and potential visual impairment. Understanding the epidemiology of this condition is crucial for healthcare providers, as it may indicate underlying systemic amyloidosis. Awareness of such conditions can lead to better population health outcomes through early detection and management, ultimately reducing healthcare utilization for complications arising from untreated ocular conditions.

ICD-9 vs ICD-10

Amyloid pterygium, while rare, can significantly affect patients' quality of life due to cosmetic concerns and potential visual impairment. Understanding the epidemiology of this condition is crucial for healthcare providers, as it may indicate underlying systemic amyloidosis. Awareness of such conditions can lead to better population health outcomes through early detection and management, ultimately reducing healthcare utilization for complications arising from untreated ocular conditions.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of surgical intervention if the lesion is symptomatic or visually significant. Common denials may arise from insufficient documentation or incorrect coding, so it is essential to verify that the diagnosis aligns with the procedures performed. Best practices include using precise coding and maintaining thorough clinical records to support claims.

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 H11.012?

H11.012 specifically covers amyloid pterygium of the left eye, characterized by amyloid deposits in the conjunctiva. It is important to differentiate it from other conjunctival lesions such as conjunctival cysts or neoplasms.

When should H11.012 be used instead of related codes?

H11.012 should be used when there is a confirmed diagnosis of amyloid pterygium specifically affecting the left eye. It is crucial to use this code when the condition is documented as such, rather than using more general codes for conjunctival disorders.

What documentation supports H11.012?

Documentation should include a detailed ocular examination, clinical findings, and, if applicable, results from a biopsy confirming amyloid deposits. Clear notes on the patient's symptoms and the impact on vision are also essential.