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ICD-10 Guide
ICD-10 CodesH11.019

H11.019

Billable

Amyloid pterygium of unspecified eye

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

Code Description

ICD-10 H11.019 is a billable code used to indicate a diagnosis of amyloid pterygium of unspecified eye.

Key Diagnostic Point:

Amyloid pterygium of the unspecified eye is a rare ocular condition characterized by the deposition of amyloid protein in the conjunctiva, leading to a yellowish-white, gelatinous appearance. This condition can affect the conjunctiva, sclera, and cornea, potentially causing discomfort, visual disturbances, or cosmetic concerns. The amyloid deposits may arise from systemic amyloidosis or localized processes, and their presence can indicate underlying systemic disease. Clinically, patients may present with a mass or thickening of the conjunctiva, which can be asymptomatic or symptomatic depending on the extent of involvement. Diagnosis is typically confirmed through histopathological examination, where Congo red staining reveals apple-green birefringence under polarized light. Disease progression can vary; while some patients may experience stable lesions, others may have progressive growth requiring intervention. Differential diagnoses include conjunctival cysts, papillomas, and other conjunctival tumors, necessitating thorough evaluation. Regular monitoring and follow-up are essential to assess for any changes in the lesions and to manage any associated symptoms effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires histopathological confirmation and differentiation from other conjunctival lesions.
  • Treatment complexity: May involve surgical excision or monitoring, depending on symptoms and progression.
  • Documentation requirements: Detailed clinical notes and pathology reports are essential for accurate coding.
  • Coding specificity: Specific to amyloid pterygium, necessitating careful selection to avoid misclassification.

Audit Risk Factors

  • Common coding errors: Misidentification of the condition or incorrect eye designation.
  • Documentation gaps: Incomplete clinical notes or lack of pathology reports.
  • Billing challenges: Potential denials due to insufficient evidence of the condition's impact on patient care.

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 cosmetic concerns and potential vision impairment. Understanding its epidemiology is crucial, as it may indicate systemic amyloidosis, which has broader implications for population health. Early diagnosis and management can lead to better outcomes and reduced healthcare utilization, emphasizing the importance of awareness among healthcare providers.

ICD-9 vs ICD-10

Amyloid pterygium, while rare, can significantly impact patients' quality of life due to cosmetic concerns and potential vision impairment. Understanding its epidemiology is crucial, as it may indicate systemic amyloidosis, which has broader implications for population health. Early diagnosis and management can lead to better outcomes and reduced healthcare utilization, emphasizing the importance of awareness among healthcare providers.

Reimbursement & Billing Impact

Reimbursement may vary based on the payer's policies regarding ocular conditions. Common denials may arise from insufficient documentation or lack of clarity regarding the condition's impact on vision or quality of life. Best practices include ensuring that all clinical findings, treatment plans, and follow-up assessments are well-documented to support the medical necessity of 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 H11.019?

H11.019 specifically covers amyloid pterygium of the unspecified eye, which is characterized by amyloid deposits in the conjunctiva. It does not cover other types of pterygium or conjunctival lesions that are not related to amyloid.

When should H11.019 be used instead of related codes?

H11.019 should be used when the amyloid pterygium is confirmed but the specific eye affected is not documented. If the right or left eye is specified, the corresponding codes H11.018 or H11.020 should be used.

What documentation supports H11.019?

Documentation for H11.019 should include a thorough clinical examination report, any imaging studies performed, and histopathological findings confirming the diagnosis of amyloid pterygium.