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ICD-10 Guide
ICD-10 CodesH11.061

H11.061

Billable

Recurrent pterygium of right eye

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

Code Description

ICD-10 H11.061 is a billable code used to indicate a diagnosis of recurrent pterygium of right eye.

Key Diagnostic Point:

H11.061 refers to recurrent pterygium of the right eye, a condition characterized by the growth of a fleshy, triangular tissue on the conjunctiva that can extend onto the cornea. This growth is often associated with chronic irritation from environmental factors such as UV light exposure, wind, and dust. Clinically, patients may present with symptoms such as redness, irritation, and visual disturbances if the pterygium encroaches on the visual axis. The anatomy involved includes the conjunctiva, which is the membrane covering the white part of the eye, and the cornea, the clear front surface of the eye. Disease progression can lead to increased size and recurrence after surgical excision, necessitating careful monitoring and management. Diagnostic considerations include a thorough eye examination, where the pterygium's size, location, and impact on vision are assessed. Differential diagnoses may include other conjunctival lesions, making accurate identification crucial for appropriate treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other conjunctival lesions.
  • Treatment complexity: Surgical intervention may be necessary, with potential for recurrence.
  • Documentation requirements: Detailed clinical notes and follow-up assessments are essential.
  • Coding specificity: Requires precise coding to reflect recurrent nature and specific eye involvement.

Audit Risk Factors

  • Common coding errors: Misidentifying the eye involved or failing to note recurrence.
  • Documentation gaps: Incomplete records of patient history and treatment outcomes.
  • Billing challenges: Potential denials if the recurrence 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

Recurrent pterygium can significantly impact patients' quality of life due to discomfort and potential vision impairment. It is prevalent in populations exposed to high UV radiation, such as those living in sunny climates. Understanding the epidemiology of pterygium can help healthcare providers implement preventive measures and improve patient outcomes through early diagnosis and effective management strategies.

ICD-9 vs ICD-10

Recurrent pterygium can significantly impact patients' quality of life due to discomfort and potential vision impairment. It is prevalent in populations exposed to high UV radiation, such as those living in sunny climates. Understanding the epidemiology of pterygium can help healthcare providers implement preventive measures and improve patient outcomes through early diagnosis and effective management strategies.

Reimbursement & Billing Impact

Reimbursement considerations may vary by payer, so it is crucial to verify coverage policies. Common denials may arise from insufficient documentation of recurrence or failure to provide evidence of prior treatments. Best practices include maintaining thorough clinical notes, ensuring accurate coding, and following up on claims to address any issues promptly.

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 H11.061?

H11.061 specifically covers recurrent pterygium of the right eye, which is characterized by the regrowth of conjunctival tissue after previous excision. It is important to differentiate this from other types of pterygium and conjunctival lesions.

When should H11.061 be used instead of related codes?

H11.061 should be used when documenting a recurrent pterygium specifically affecting the right eye. If the condition is unilateral but not recurrent, or if it affects the left eye, other codes such as H11.062 or H11.059 may be more appropriate.

What documentation supports H11.061?

Documentation should include a detailed history of the patient's eye condition, previous treatments, surgical notes, and follow-up assessments that confirm the recurrence of the pterygium on the right eye.