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ICD-10 Guide
ICD-10 CodesH11.03

H11.03

Non-billable

Double pterygium of eye

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

Code Description

ICD-10 H11.03 is a used to indicate a diagnosis of double pterygium of eye.

Key Diagnostic Point:

Double pterygium of the eye is characterized by the presence of two pterygia, which are abnormal growths of conjunctival tissue that extend onto the cornea. This condition typically arises due to prolonged exposure to ultraviolet light, dust, and wind, leading to conjunctival inflammation and subsequent fibrovascular proliferation. Clinically, patients may present with symptoms such as irritation, redness, and visual disturbances, particularly if the pterygia encroach upon the visual axis. The anatomy involved includes the conjunctiva, cornea, and potentially the sclera, as the growths can affect these structures. Disease progression can lead to increased size of the pterygia, which may necessitate surgical intervention if they cause significant visual impairment or discomfort. Diagnostic considerations include a thorough eye examination, where the ophthalmologist assesses the size, location, and impact of the pterygia on visual function, often utilizing slit-lamp biomicroscopy for detailed evaluation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other conjunctival lesions.
  • Treatment complexity: May involve surgical excision, which requires careful planning and follow-up.
  • Documentation requirements: Detailed clinical notes are essential to support the diagnosis and treatment plan.
  • Coding specificity: Requires accurate coding to reflect the specific type and extent of the condition.

Audit Risk Factors

  • Common coding errors: Misidentification of pterygium type or number.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and 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

Double pterygium can significantly affect a patient's quality of life, leading to discomfort and visual impairment. The condition is more prevalent in populations with high sun exposure, highlighting the importance of preventive measures such as UV protection. Understanding the epidemiology of pterygium can inform public health initiatives aimed at reducing incidence rates. Quality measures may include tracking surgical outcomes and patient satisfaction post-treatment, which can guide improvements in care delivery.

ICD-9 vs ICD-10

Double pterygium can significantly affect a patient's quality of life, leading to discomfort and visual impairment. The condition is more prevalent in populations with high sun exposure, highlighting the importance of preventive measures such as UV protection. Understanding the epidemiology of pterygium can inform public health initiatives aimed at reducing incidence rates. Quality measures may include tracking surgical outcomes and patient satisfaction post-treatment, which can guide improvements in care delivery.

Reimbursement & Billing Impact

Reimbursement considerations include the medical necessity for surgical intervention, which must be clearly articulated in the clinical notes. Common denials may arise from insufficient documentation of symptoms or the rationale for surgery. Best practices include ensuring that all relevant clinical findings are documented and that the coding accurately reflects the complexity of the condition. Additionally, pre-authorization may be required by some insurers for surgical procedures related to pterygium.

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 H11.03?

H11.03 specifically covers double pterygium, which is characterized by two distinct pterygia affecting the eye. It is important to differentiate this from other conjunctival disorders such as pinguecula or single pterygium (H11.02).

When should H11.03 be used instead of related codes?

H11.03 should be used when both pterygia are present and affecting the eye, particularly when they cause visual impairment or significant symptoms. If only one pterygium is present, H11.02 should be used.

What documentation supports H11.03?

Documentation should include a comprehensive eye examination report detailing the presence of double pterygium, associated symptoms, and any treatment plans. Photographic evidence and notes on the impact on visual acuity can also support the diagnosis.