ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesH11.152

H11.152

Billable

Pinguecula, left eye

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

Code Description

ICD-10 H11.152 is a billable code used to indicate a diagnosis of pinguecula, left eye.

Key Diagnostic Point:

Pinguecula is a benign growth on the conjunctiva, typically appearing as a yellowish, raised lesion on the sclera, often located on the nasal side of the eye. It is primarily composed of elastic tissue and is associated with chronic exposure to UV light, dust, and wind. Clinically, patients may present with irritation, redness, or a foreign body sensation, although many remain asymptomatic. The anatomy involved includes the conjunctiva, which is the membrane covering the sclera and lining the eyelids. Disease progression is generally slow, and while pingueculae are not known to cause significant vision impairment, they can lead to discomfort or cosmetic concerns. Diagnostic considerations include a thorough eye examination, where the lesion's characteristics, such as size, location, and associated symptoms, are evaluated. Differential diagnoses may include pterygium, conjunctival cysts, or other conjunctival lesions, necessitating careful assessment to ensure accurate coding and treatment planning.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low - Diagnosis is typically straightforward based on clinical examination.
  • Treatment complexity: Low - Treatment may involve observation or topical lubricants; surgical intervention is rare.
  • Documentation requirements: Medium - Requires clear documentation of symptoms and examination findings.
  • Coding specificity: Medium - Specific to left eye, requiring attention to detail in coding.

Audit Risk Factors

  • Common coding errors: Misidentifying pinguecula as pterygium.
  • Documentation gaps: Lack of detailed symptom description or examination findings.
  • Billing challenges: Potential denials if the condition is not well-documented or if the treatment is not clearly justified.

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

Pinguecula is a common condition, particularly in populations with high UV exposure, such as outdoor workers. Its clinical significance lies in its potential to cause discomfort and cosmetic concerns, impacting quality of life. Understanding the epidemiology of pinguecula can help healthcare providers identify at-risk populations and implement preventive measures, such as UV protection. Quality measures may include patient education on eye health and the importance of regular eye examinations.

ICD-9 vs ICD-10

Pinguecula is a common condition, particularly in populations with high UV exposure, such as outdoor workers. Its clinical significance lies in its potential to cause discomfort and cosmetic concerns, impacting quality of life. Understanding the epidemiology of pinguecula can help healthcare providers identify at-risk populations and implement preventive measures, such as UV protection. Quality measures may include patient education on eye health and the importance of regular eye examinations.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for ophthalmological services. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for treatment. Best practices include maintaining thorough records of patient symptoms, examination findings, and any treatments provided, as well as ensuring that the coding accurately reflects the diagnosis and any procedures performed.

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 H11.152?

H11.152 specifically covers pinguecula of the left eye. It is characterized by a yellowish, raised lesion on the conjunctiva, typically associated with environmental factors such as UV exposure.

When should H11.152 be used instead of related codes?

H11.152 should be used when the diagnosis is confirmed as pinguecula in the left eye, differentiating it from other conjunctival lesions or conditions such as pterygium, which has different implications for treatment and management.

What documentation supports H11.152?

Documentation should include a detailed eye examination report noting the presence of the pinguecula, its location, size, and any associated symptoms. Photographic evidence may also support the diagnosis.