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ICD-10 Guide
ICD-10 CodesH11.139

H11.139

Billable

Conjunctival pigmentations, unspecified eye

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

Code Description

ICD-10 H11.139 is a billable code used to indicate a diagnosis of conjunctival pigmentations, unspecified eye.

Key Diagnostic Point:

H11.139 refers to conjunctival pigmentations of unspecified eye, which can manifest as localized or diffuse pigmentation on the conjunctiva. The conjunctiva is a thin, transparent membrane that covers the white part of the eye (sclera) and lines the inside of the eyelids. These pigmentations can arise from various etiologies, including benign conditions such as conjunctival nevi or more concerning conditions like melanosis or even conjunctival melanoma. Clinically, patients may present with asymptomatic lesions, or they may report changes in vision or irritation. The progression of conjunctival pigmentations can vary; some may remain stable, while others may change in size or color, warranting further investigation. Diagnostic considerations include a thorough ocular examination, possibly supplemented by imaging techniques or biopsy to ascertain the nature of the pigmentation. Given the potential for malignant transformation, timely diagnosis and management are crucial.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misidentifying the eye involved or failing to document the nature of the pigmentation.
  • Documentation gaps may arise if the clinical rationale for the diagnosis is not clearly articulated.
  • Billing challenges can occur if the condition is not well-defined, leading to potential denials.

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 H11.139 lies in its potential for identifying benign versus malignant conjunctival lesions, impacting patient management and outcomes. Population health considerations include the prevalence of conjunctival pigmentations in various demographics, with a focus on early detection and treatment to prevent complications. Quality measures may involve tracking the rates of timely referrals for suspicious lesions and ensuring appropriate follow-up care, which can influence healthcare utilization patterns.

ICD-9 vs ICD-10

The clinical significance of H11.139 lies in its potential for identifying benign versus malignant conjunctival lesions, impacting patient management and outcomes. Population health considerations include the prevalence of conjunctival pigmentations in various demographics, with a focus on early detection and treatment to prevent complications. Quality measures may involve tracking the rates of timely referrals for suspicious lesions and ensuring appropriate follow-up care, which can influence healthcare utilization patterns.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for ophthalmological evaluations and potential treatments. Common denials may arise from insufficient documentation or lack of specificity in the diagnosis. Best practices include maintaining thorough records of patient history, examination findings, and any treatments provided to support the medical necessity of the services rendered.

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 H11.139?

H11.139 covers various conjunctival pigmentations, including but not limited to conjunctival nevi, melanosis, and other pigmented lesions that do not have a specified diagnosis. It is essential to differentiate these from malignant conditions such as conjunctival melanoma.

When should H11.139 be used instead of related codes?

H11.139 should be used when the specific eye involved is not documented, or when the pigmentation does not fit the criteria for more specific codes. It is crucial to ensure that the clinical documentation supports the use of this unspecified code.

What documentation supports H11.139?

Documentation should include a detailed ocular examination report, descriptions of the pigmentation, any symptoms reported by the patient, and the clinical rationale for the diagnosis. Photographic evidence may also be beneficial.