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ICD-10 Guide
ICD-10 CodesH11.10

H11.10

Billable

Unspecified conjunctival degenerations

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

Code Description

ICD-10 H11.10 is a billable code used to indicate a diagnosis of unspecified conjunctival degenerations.

Key Diagnostic Point:

H11.10 refers to unspecified conjunctival degenerations, which are characterized by the deterioration of the conjunctiva, the thin membrane covering the white part of the eye and the inner surface of the eyelids. Clinically, patients may present with symptoms such as redness, irritation, and discomfort in the eye. The conjunctiva plays a crucial role in protecting the eye and maintaining moisture, and degenerative changes can lead to complications such as dryness, inflammation, or even vision impairment if left untreated. The disease progression can vary, with some patients experiencing mild symptoms while others may develop more severe conditions requiring intervention. Diagnostic considerations include a thorough ocular examination, patient history, and potentially imaging studies to assess the extent of degeneration. Differential diagnoses may include conjunctivitis, pterygium, or other anterior segment disorders, necessitating careful evaluation to ensure accurate coding and treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive eye examination and differential diagnosis.
  • Treatment complexity: May involve topical medications, surgical interventions, or referrals to specialists.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis and treatment plan.
  • Coding specificity: Limited specificity as it is classified as 'unspecified,' which may lead to challenges in data analysis.

Audit Risk Factors

  • Common coding errors: Misclassification with other conjunctival conditions.
  • Documentation gaps: Incomplete patient history or examination findings.
  • Billing challenges: Potential denials due to lack of specificity in the diagnosis.

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

Primary care

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 H11.10 lies in its potential to affect patient quality of life due to discomfort and vision-related issues. Understanding conjunctival degenerations is vital for population health, as these conditions can indicate broader systemic issues. Quality measures may include monitoring the incidence of conjunctival disorders and ensuring timely interventions to prevent complications. Epidemiologically, conjunctival degenerations are prevalent in aging populations and those exposed to environmental irritants, highlighting the need for awareness and preventive care strategies.

ICD-9 vs ICD-10

The clinical significance of H11.10 lies in its potential to affect patient quality of life due to discomfort and vision-related issues. Understanding conjunctival degenerations is vital for population health, as these conditions can indicate broader systemic issues. Quality measures may include monitoring the incidence of conjunctival disorders and ensuring timely interventions to prevent complications. Epidemiologically, conjunctival degenerations are prevalent in aging populations and those exposed to environmental irritants, highlighting the need for awareness and preventive care strategies.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, and it is crucial to provide detailed clinical notes that outline the patient's symptoms and the rationale for the diagnosis. Common denials may arise from insufficient documentation or lack of specificity, so coders should ensure that all relevant information is included in the claim. Best practices include using modifiers when necessary and verifying coverage policies with payers to avoid billing issues.

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 H11.10?

H11.10 encompasses a range of unspecified conjunctival degenerations, which may include changes due to aging, environmental factors, or underlying systemic diseases. Specific conditions may not be detailed under this code, necessitating further investigation to identify the exact nature of the degeneration.

When should H11.10 be used instead of related codes?

H11.10 should be used when the clinician has identified conjunctival degeneration but has not specified the type or cause. If a more specific diagnosis is available, such as pterygium or conjunctival cyst, those codes should be utilized instead.

What documentation supports H11.10?

Documentation should include a comprehensive eye examination report, patient symptoms, any relevant medical history, and the clinician's assessment of the conjunctival condition. Clear notes on the absence of specific degenerative conditions will support the use of H11.10.