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ICD-10 Guide
ICD-10 CodesH11.06

H11.06

Non-billable

Recurrent pterygium of eye

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

Code Description

ICD-10 H11.06 is a used to indicate a diagnosis of recurrent pterygium of eye.

Key Diagnostic Point:

Recurrent pterygium of the eye is characterized by the growth of a fleshy, triangular tissue on the conjunctiva that can invade the cornea. This condition often arises after surgical excision of a primary pterygium, leading to its recurrence. Clinically, patients may present with symptoms such as redness, irritation, and visual disturbances due to corneal involvement. The anatomy involved includes the conjunctiva, sclera, and cornea, with the anterior segment of the eye being significantly affected. Disease progression can lead to increased corneal astigmatism and potential vision loss if left untreated. Diagnostic considerations include a thorough ocular examination, assessment of visual acuity, and possibly imaging studies to evaluate the extent of the pterygium. The recurrent nature of this condition necessitates careful monitoring and management to prevent further complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassifying the type of pterygium.
  • Documentation gaps may arise if the recurrence is not clearly noted.
  • Billing challenges can occur if the treatment plan 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

Recurrent pterygium has significant clinical implications, as it can lead to visual impairment and affect quality of life. The condition is prevalent in populations exposed to UV light and dust, highlighting the importance of preventive measures. Understanding the epidemiology of pterygium can inform public health initiatives aimed at reducing its incidence and improving eye health outcomes.

ICD-9 vs ICD-10

Recurrent pterygium has significant clinical implications, as it can lead to visual impairment and affect quality of life. The condition is prevalent in populations exposed to UV light and dust, highlighting the importance of preventive measures. Understanding the epidemiology of pterygium can inform public health initiatives aimed at reducing its incidence and improving eye health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the surgical procedure and the need for follow-up care. Common denials may arise if the recurrence is not well-documented or if the treatment plan lacks clarity. Best practices include ensuring that all relevant clinical notes, surgical reports, and follow-up assessments are included in the patient's medical record to support the billing process.

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 H11.06?

H11.06 specifically covers recurrent pterygium of the eye, which is a growth that reappears after surgical removal. It is important to differentiate it from primary pterygium and other conjunctival lesions.

When should H11.06 be used instead of related codes?

H11.06 should be used when there is a documented history of pterygium that has recurred after treatment. If the pterygium is primary and has not recurred, H11.05 should be used instead.

What documentation supports H11.06?

Documentation should include a detailed history of the patient's prior pterygium treatment, evidence of recurrence, and any associated symptoms or complications. Surgical notes and follow-up assessments are crucial.