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ICD-10 Guide
ICD-10 CodesH11.063

H11.063

Billable

Recurrent pterygium of eye, bilateral

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

Code Description

ICD-10 H11.063 is a billable code used to indicate a diagnosis of recurrent pterygium of eye, bilateral.

Key Diagnostic Point:

Recurrent pterygium of the eye, bilateral, is characterized by the growth of fleshy tissue on the conjunctiva that can extend onto the cornea. This condition often arises after surgical excision of a primary pterygium and is more prevalent in individuals with prolonged sun exposure, dry eyes, or chronic irritation. The anatomy involved includes the conjunctiva, which is the membrane covering the white part of the eye, the sclera, and the cornea. Clinically, patients may present with symptoms such as redness, irritation, and visual disturbances due to corneal involvement. Disease progression can lead to increased discomfort and potential vision impairment if the pterygium encroaches on the visual axis. Diagnostic considerations include a thorough eye examination, often supplemented by slit-lamp biomicroscopy to assess the extent of the pterygium and its impact on the ocular surface. Management may involve surgical intervention, particularly if the pterygium is recurrent and symptomatic, alongside addressing any underlying causes such as environmental factors.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful differentiation from other conjunctival lesions.
  • Treatment complexity: May involve surgical intervention and management of recurrence.
  • Documentation requirements: Detailed clinical notes and follow-up assessments are essential.
  • Coding specificity: Requires precise coding to differentiate between types of pterygium.

Audit Risk Factors

  • Common coding errors: Misclassification of unilateral versus bilateral pterygium.
  • Documentation gaps: Incomplete records of prior pterygium surgeries or treatments.
  • Billing challenges: Denials may arise from insufficient documentation of recurrent nature.

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

Dermatology

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 affect patients' quality of life due to discomfort and potential vision impairment. It is particularly relevant in populations with high sun exposure or environmental irritants. Understanding the epidemiology of pterygium can help healthcare providers implement preventive measures and improve patient outcomes. Quality measures may include tracking recurrence rates and patient satisfaction post-surgery, which can inform healthcare utilization patterns and resource allocation.

ICD-9 vs ICD-10

Recurrent pterygium can significantly affect patients' quality of life due to discomfort and potential vision impairment. It is particularly relevant in populations with high sun exposure or environmental irritants. Understanding the epidemiology of pterygium can help healthcare providers implement preventive measures and improve patient outcomes. Quality measures may include tracking recurrence rates and patient satisfaction post-surgery, which can inform healthcare utilization patterns and resource allocation.

Reimbursement & Billing Impact

Reimbursement considerations include understanding payer policies regarding surgical interventions for recurrent pterygium. Common denials may occur if documentation does not adequately support the necessity of the procedure. Best practices include maintaining thorough records and ensuring that coding accurately reflects the clinical scenario to minimize audit risks.

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 H11.063?

H11.063 specifically covers recurrent bilateral pterygium, which is characterized by the regrowth of conjunctival tissue after surgical excision. It is important to differentiate this from primary pterygium and other conjunctival lesions.

When should H11.063 be used instead of related codes?

H11.063 should be used when documenting recurrent bilateral pterygium, particularly after previous surgical intervention. It is distinct from unilateral codes and should be selected based on the patient's clinical presentation.

What documentation supports H11.063?

Documentation should include a detailed history of the patient's ocular condition, previous treatments, surgical notes, and current symptoms. Follow-up assessments and visual acuity tests are also critical to support the diagnosis.