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ICD-10 Guide
ICD-10 CodesH11.02

H11.02

Non-billable

Central pterygium of eye

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

Code Description

ICD-10 H11.02 is a used to indicate a diagnosis of central pterygium of eye.

Key Diagnostic Point:

Central pterygium of the eye is a growth of fleshy tissue on the conjunctiva that extends onto the cornea, typically originating from the nasal side. This condition is characterized by a triangular-shaped encroachment that can lead to visual impairment if it progresses significantly. The conjunctiva, sclera, and cornea are the primary anatomical structures involved, with the pterygium affecting the conjunctival surface and potentially altering the corneal curvature. Clinically, patients may present with symptoms such as irritation, redness, and a foreign body sensation. Over time, the pterygium may become inflamed or even cause astigmatism due to its effect on the corneal surface. Diagnostic considerations include a thorough eye examination, where the growth's size, location, and any associated symptoms are assessed. Differential diagnoses may include pinguecula and other conjunctival lesions. Treatment options vary based on severity and may include observation, topical medications for inflammation, or surgical excision in cases of significant visual impairment or discomfort.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires differentiation from other conjunctival lesions.
  • Treatment complexity: Moderate, with options ranging from conservative management to surgical intervention.
  • Documentation requirements: Requires detailed clinical notes and possibly imaging for surgical cases.
  • Coding specificity: Specific to central pterygium, but related codes exist for other types of pterygium.

Audit Risk Factors

  • Common coding errors: Misclassification with other conjunctival disorders.
  • Documentation gaps: Incomplete clinical notes regarding the extent of the pterygium.
  • Billing challenges: Potential denials if the necessity for surgical intervention is not well-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

Optometry

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

Central pterygium can significantly affect visual acuity and quality of life, particularly in populations exposed to UV light or environmental irritants. Understanding its prevalence and impact on healthcare utilization is essential for developing preventive strategies. Quality measures may include tracking the incidence of pterygium and the outcomes of surgical interventions, which can inform public health initiatives aimed at reducing risk factors associated with this condition.

ICD-9 vs ICD-10

Central pterygium can significantly affect visual acuity and quality of life, particularly in populations exposed to UV light or environmental irritants. Understanding its prevalence and impact on healthcare utilization is essential for developing preventive strategies. Quality measures may include tracking the incidence of pterygium and the outcomes of surgical interventions, which can inform public health initiatives aimed at reducing risk factors associated with this condition.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the pterygium and whether surgical intervention is warranted. Common denials may arise if the documentation does not clearly support the need for surgery or if the diagnosis is not well-defined. Best practices include ensuring that all clinical notes are thorough and that any surgical procedures are justified with appropriate clinical evidence.

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 H11.02?

H11.02 specifically covers central pterygium of the eye, characterized by a triangular growth on the conjunctiva that extends onto the cornea. It is differentiated from other conditions such as pinguecula and peripheral pterygium.

When should H11.02 be used instead of related codes?

H11.02 should be used when the pterygium is specifically central and affecting the cornea. If the pterygium is peripheral or if it is a pinguecula, then other codes such as H11.01 or H11.03 should be considered.

What documentation supports H11.02?

Documentation should include a detailed clinical examination note describing the size, location, and symptoms associated with the pterygium. Photographic evidence or imaging may also be beneficial, especially if surgical intervention is planned.