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ICD-10 Guide
ICD-10 CodesH11.212

H11.212

Billable

Conjunctival adhesions and strands (localized), left eye

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

Code Description

ICD-10 H11.212 is a billable code used to indicate a diagnosis of conjunctival adhesions and strands (localized), left eye.

Key Diagnostic Point:

Conjunctival adhesions and strands (localized) in the left eye refer to abnormal fibrous connections between the conjunctiva and adjacent ocular structures, which can impede normal eye movement and cause discomfort. The conjunctiva is a thin, transparent membrane covering the sclera and lining the eyelids, playing a crucial role in protecting the eye and maintaining moisture. These adhesions can arise from various conditions, including chronic inflammation, previous ocular surgeries, or trauma. Clinically, patients may present with symptoms such as redness, irritation, and restricted eye movement. Disease progression can lead to more significant ocular complications if left untreated, including corneal exposure and potential vision impairment. Diagnostic considerations include a thorough ocular examination, slit-lamp biomicroscopy, and possibly imaging studies to assess the extent of the adhesions. Differentiating localized conjunctival adhesions from other conjunctival or scleral disorders is essential for appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires detailed ocular examination and history.
  • Treatment complexity: May involve surgical intervention or conservative management.
  • Documentation requirements: Must clearly document the nature and extent of adhesions.
  • Coding specificity: Requires precise coding to differentiate from other conjunctival conditions.

Audit Risk Factors

  • Common coding errors: Misidentifying the eye involved or failing to document the nature of the adhesions.
  • Documentation gaps: Incomplete clinical notes regarding the patient's history and examination findings.
  • Billing challenges: Potential denials if documentation does not support the diagnosis or if coding is not specific.

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

The clinical significance of H11.212 lies in its potential to affect patient comfort and ocular health. Localized conjunctival adhesions can lead to complications such as corneal exposure and vision impairment if not addressed. Understanding the epidemiology of conjunctival disorders can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures may include monitoring patient outcomes post-treatment and ensuring adherence to clinical guidelines for managing conjunctival conditions.

ICD-9 vs ICD-10

The clinical significance of H11.212 lies in its potential to affect patient comfort and ocular health. Localized conjunctival adhesions can lead to complications such as corneal exposure and vision impairment if not addressed. Understanding the epidemiology of conjunctival disorders can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures may include monitoring patient outcomes post-treatment and ensuring adherence to clinical guidelines for managing conjunctival conditions.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is well-supported by clinical documentation, particularly if surgical intervention is performed. Common denials may arise from insufficient documentation or lack of specificity in coding. Best practices include maintaining thorough records of patient history, examination findings, and treatment plans to substantiate claims and facilitate smoother billing processes.

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 H11.212?

H11.212 covers localized conjunctival adhesions and strands in the left eye, which may result from chronic conjunctivitis, surgical interventions, or trauma. It is essential to differentiate these from other conjunctival disorders such as conjunctival cysts or pterygium.

When should H11.212 be used instead of related codes?

H11.212 should be used when the clinical documentation specifically indicates localized conjunctival adhesions in the left eye, as opposed to generalized conditions or adhesions in the right eye or other ocular structures.

What documentation supports H11.212?

Documentation should include a detailed ocular examination report, noting the presence of adhesions, their location, and any associated symptoms. Surgical notes or treatment plans may also be necessary if intervention is performed.