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ICD-10 Guide
ICD-10 CodesH11.132

H11.132

Billable

Conjunctival pigmentations, left eye

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

Code Description

ICD-10 H11.132 is a billable code used to indicate a diagnosis of conjunctival pigmentations, left eye.

Key Diagnostic Point:

H11.132 refers to conjunctival pigmentations in the left eye, which are localized deposits of pigment within the conjunctiva, the thin membrane covering the white part of the eye and the inner surface of the eyelids. These pigmentations can vary in appearance, ranging from flat, brownish spots to more elevated lesions. Clinically, they may be asymptomatic but can sometimes cause irritation or cosmetic concerns for patients. The conjunctiva is richly vascularized and plays a crucial role in protecting the eye and maintaining ocular surface health. Disease progression can be benign, but in some cases, these pigmentations may indicate underlying conditions such as conjunctival nevi or even malignant lesions. Diagnostic considerations include a thorough ocular examination, often supplemented by slit-lamp biomicroscopy to assess the characteristics of the pigmentation. In some cases, a biopsy may be warranted to rule out malignancy. Regular monitoring is essential to detect any changes in size, shape, or color, which could indicate a need for further intervention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful differentiation from other conjunctival lesions.
  • Treatment complexity: Generally low, but may require surgical intervention if malignancy is suspected.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis.
  • Coding specificity: Specific to left eye pigmentation, which requires accurate coding.

Audit Risk Factors

  • Common coding errors: Misidentifying the eye involved or confusing with other conjunctival conditions.
  • Documentation gaps: Incomplete clinical notes regarding the nature and progression of the pigmentation.
  • Billing challenges: Potential denials if the documentation does not clearly 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

Conjunctival pigmentations, while often benign, can have significant implications for patient health and quality of life. They may lead to increased healthcare utilization due to patient concerns about appearance or potential malignancy. Understanding the epidemiology of these conditions is crucial, as they can vary in prevalence among different populations. Quality measures related to eye health often include monitoring such conditions to prevent complications and ensure timely intervention when necessary.

ICD-9 vs ICD-10

Conjunctival pigmentations, while often benign, can have significant implications for patient health and quality of life. They may lead to increased healthcare utilization due to patient concerns about appearance or potential malignancy. Understanding the epidemiology of these conditions is crucial, as they can vary in prevalence among different populations. Quality measures related to eye health often include monitoring such conditions to prevent complications and ensure timely intervention when necessary.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for ophthalmological evaluations and any necessary procedures. Common denials may arise from insufficient documentation or incorrect coding of the eye involved. To avoid these issues, coders should ensure that all clinical findings are well-documented and that the coding reflects the specific nature of the condition. Best practices include using precise terminology and ensuring that the medical necessity for any procedures is clearly articulated in the clinical notes.

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 H11.132?

H11.132 specifically covers benign conjunctival pigmentations, such as conjunctival nevi and other pigmented lesions that do not exhibit signs of malignancy. It does not cover conditions like conjunctival melanoma or other ocular surface tumors.

When should H11.132 be used instead of related codes?

H11.132 should be used when the diagnosis specifically involves pigmentations in the left eye that are confirmed to be benign. If there are signs of malignancy or if the pigmentation is in the right eye, other codes should be selected.

What documentation supports H11.132?

Documentation should include a detailed ocular examination report, noting the characteristics of the pigmentation, any symptoms reported by the patient, and the clinical decision-making process regarding monitoring or treatment.