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ICD-10 Guide
ICD-10 CodesH11.2

H11.2

Non-billable

Conjunctival scars

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

Code Description

ICD-10 H11.2 is a used to indicate a diagnosis of conjunctival scars.

Key Diagnostic Point:

Conjunctival scars are fibrous tissue formations that occur on the conjunctiva, the thin membrane covering the white part of the eyeball and the inner surface of the eyelids. These scars can arise from various causes, including trauma, surgical procedures, infections, or chronic inflammatory conditions. Clinically, patients may present with symptoms such as irritation, redness, or discomfort, and in some cases, visual disturbances if the scar affects adjacent structures. The anatomy involved includes the conjunctiva, which plays a crucial role in maintaining ocular surface health and protecting the eye from environmental factors. Disease progression can vary; while some scars may remain stable, others can lead to complications such as conjunctival cysts or pterygium formation. Diagnostic considerations include a thorough ocular examination, patient history, and possibly imaging studies to assess the extent of the scarring and its impact on surrounding tissues. Treatment options may range from observation to surgical intervention, depending on the severity and symptoms associated with the conjunctival scar.

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 misclassification of conjunctival conditions.
  • Documentation gaps may arise if the cause of the scar is not clearly stated.
  • Billing challenges can occur if the treatment provided is not adequately supported by clinical documentation.

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

Optometry

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

Conjunctival scars can significantly affect a patient's quality of life, leading to discomfort and potential visual impairment. Understanding the epidemiology of conjunctival scarring is crucial, as it can arise from various underlying conditions, including infections and trauma. Addressing these issues can improve population health outcomes and reduce healthcare utilization by preventing complications associated with untreated conjunctival conditions.

ICD-9 vs ICD-10

Conjunctival scars can significantly affect a patient's quality of life, leading to discomfort and potential visual impairment. Understanding the epidemiology of conjunctival scarring is crucial, as it can arise from various underlying conditions, including infections and trauma. Addressing these issues can improve population health outcomes and reduce healthcare utilization by preventing complications associated with untreated conjunctival conditions.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the medical necessity of any procedures performed, as well as ensuring that the coding aligns with the services rendered. Common denials may arise from insufficient documentation or failure to establish the relationship between the diagnosis and the treatment provided. Best practices include maintaining thorough records of patient evaluations, treatment plans, and follow-up care to substantiate claims.

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 H11.2?

H11.2 covers conjunctival scars resulting from trauma, surgery, or chronic inflammation. It does not include scars from other ocular structures such as the cornea or sclera.

When should H11.2 be used instead of related codes?

H11.2 should be used when the primary issue is a scar on the conjunctiva itself, as opposed to other conditions affecting the conjunctiva or adjacent structures.

What documentation supports H11.2?

Documentation should include a detailed patient history, the cause of the conjunctival scar, symptoms experienced, and results from ocular examinations.