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ICD-10 Guide
ICD-10 CodesH11.131

H11.131

Billable

Conjunctival pigmentations, right eye

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

Code Description

ICD-10 H11.131 is a billable code used to indicate a diagnosis of conjunctival pigmentations, right eye.

Key Diagnostic Point:

H11.131 refers to conjunctival pigmentations in the right eye, which are localized deposits of pigment in the conjunctiva, the clear membrane covering the white part of the eye and the inner eyelids. These pigmentations can be benign or indicative of underlying conditions. Clinically, they may present as brown or black spots and can vary in size and shape. The conjunctiva is richly vascularized and plays a crucial role in protecting the eye and maintaining moisture. Disease progression can be slow, with pigmentations remaining stable over time, but changes in size or color may warrant further investigation. Diagnostic considerations include a thorough ocular examination, slit-lamp biomicroscopy, and possibly a biopsy if malignancy is suspected. Differential diagnoses may include conjunctival nevi, melanosis, or even conjunctival tumors. Understanding the anatomy involved, including the conjunctiva's role in ocular health, is essential for accurate diagnosis and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other conjunctival lesions.
  • Treatment complexity: Generally low, but monitoring may be necessary.
  • Documentation requirements: Detailed clinical notes and visual documentation are essential.
  • Coding specificity: Specific to the right eye, necessitating precise coding.

Audit Risk Factors

  • Common coding errors: Misidentification of the eye involved.
  • Documentation gaps: Lack of detailed clinical notes on the nature of the pigmentation.
  • Billing challenges: Potential for denials if documentation does not support 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

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of H11.131 lies in its potential to indicate underlying ocular conditions that may require monitoring or intervention. Population health impact is minimal for benign cases, but awareness of conjunctival pigmentations can lead to early detection of more serious conditions. Quality measures may include the frequency of eye examinations and documentation completeness. Healthcare utilization patterns may reflect increased visits for ocular assessments, particularly in populations at risk for ocular malignancies.

ICD-9 vs ICD-10

The clinical significance of H11.131 lies in its potential to indicate underlying ocular conditions that may require monitoring or intervention. Population health impact is minimal for benign cases, but awareness of conjunctival pigmentations can lead to early detection of more serious conditions. Quality measures may include the frequency of eye examinations and documentation completeness. Healthcare utilization patterns may reflect increased visits for ocular assessments, particularly in populations at risk for ocular malignancies.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for ophthalmological evaluations and ensuring that all services rendered are documented accurately. Common denials may arise from insufficient documentation or failure to specify the eye involved. Best practices include maintaining thorough clinical notes, using appropriate modifiers when necessary, and ensuring that all coding aligns with the documented findings.

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 H11.131?

H11.131 covers benign conjunctival pigmentations, including conjunctival nevi and melanosis. It does not include malignant conditions, which would require different coding.

When should H11.131 be used instead of related codes?

H11.131 should be used when the pigmentation is specifically located in the right eye and is determined to be benign. If the pigmentation is in the left eye, H11.132 should be used, and for unspecified eye conditions, H11.139 is appropriate.

What documentation supports H11.131?

Documentation should include a comprehensive eye examination report, details of the pigmentation's characteristics, and any imaging or biopsy results if performed.