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ICD-10 Guide
ICD-10 CodesH11.023

H11.023

Billable

Central pterygium of eye, bilateral

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

Code Description

ICD-10 H11.023 is a billable code used to indicate a diagnosis of central pterygium of eye, bilateral.

Key Diagnostic Point:

Central pterygium of the eye, bilateral, is characterized by a triangular fibrovascular growth that extends from the conjunctiva onto the cornea, affecting both eyes. This condition often arises due to chronic exposure to UV light, dust, and wind, leading to irritation and inflammation of the conjunctival tissue. Clinically, patients may present with symptoms such as redness, irritation, and visual disturbances due to the encroachment of the pterygium on the visual axis. The anatomy involved includes the conjunctiva, sclera, and cornea, with potential implications for the anterior segment of the eye. Disease progression can lead to increased growth of the pterygium, which may necessitate surgical intervention if it significantly impairs vision or causes discomfort. Diagnostic considerations include a thorough ocular examination, assessment of visual acuity, and possibly imaging studies to evaluate the extent of the pterygium. Early diagnosis and management are crucial to prevent complications such as astigmatism or recurrent growth post-surgery.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive eye examination and differentiation from other conjunctival lesions.
  • Treatment complexity: May involve medical management or surgical intervention depending on severity.
  • Documentation requirements: Detailed clinical notes are necessary to justify the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate between unilateral and bilateral conditions.

Audit Risk Factors

  • Common coding errors: Misclassification as unilateral pterygium or incorrect documentation of severity.
  • Documentation gaps: Lack of detailed clinical findings or treatment rationale.
  • Billing challenges: Potential denials if the medical necessity for surgery is not clearly 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

The clinical significance of H11.023 lies in its potential to affect visual acuity and quality of life for patients. Population health impact includes increased healthcare utilization for surgical interventions and follow-up care. Quality measures may focus on the timely diagnosis and management of pterygium to prevent complications. Epidemiologically, the condition is more prevalent in populations with high UV exposure, highlighting the need for preventive measures and awareness.

ICD-9 vs ICD-10

The clinical significance of H11.023 lies in its potential to affect visual acuity and quality of life for patients. Population health impact includes increased healthcare utilization for surgical interventions and follow-up care. Quality measures may focus on the timely diagnosis and management of pterygium to prevent complications. Epidemiologically, the condition is more prevalent in populations with high UV exposure, highlighting the need for preventive measures and awareness.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of surgical intervention if the pterygium affects vision or causes discomfort. Common denials may arise from insufficient documentation of the condition's impact on the patient's daily life or visual function. Best practices include ensuring that all clinical findings are clearly documented and that the medical necessity for any procedures is well-supported in the patient's medical record.

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 H11.023?

H11.023 specifically covers bilateral central pterygium, which is a growth of conjunctival tissue onto the cornea. It is important to differentiate it from other types of pterygium and conjunctival lesions.

When should H11.023 be used instead of related codes?

H11.023 should be used when both eyes are affected by central pterygium, particularly when the condition is documented as bilateral and impacting visual function.

What documentation supports H11.023?

Documentation should include a detailed ocular examination, patient symptoms, visual acuity measurements, and any treatment plans or interventions undertaken.