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ICD-10 Guide
ICD-10 CodesH11.213

H11.213

Billable

Conjunctival adhesions and strands (localized), bilateral

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

Code Description

ICD-10 H11.213 is a billable code used to indicate a diagnosis of conjunctival adhesions and strands (localized), bilateral.

Key Diagnostic Point:

Conjunctival adhesions and strands (localized), bilateral, refer to abnormal fibrous connections that develop between the conjunctiva and adjacent ocular structures, such as the sclera or cornea. These adhesions can arise due to various factors, including chronic inflammation, trauma, or surgical interventions. Clinically, patients may present with symptoms such as discomfort, visual disturbances, or restricted eye movement. The conjunctiva, a thin membrane covering the sclera and lining the eyelids, plays a crucial role in ocular health. When localized adhesions occur bilaterally, they can significantly impact the anterior segment of the eye, leading to complications like dry eye syndrome or corneal scarring. Disease progression can vary; in some cases, the condition may stabilize, while in others, it may worsen, necessitating surgical intervention. Diagnostic considerations include a comprehensive ocular examination, slit-lamp biomicroscopy, and possibly imaging studies to assess the extent of adhesions and their impact on surrounding structures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough ocular examination and differential diagnosis.
  • Treatment complexity: May involve medical management or surgical intervention.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Requires precise coding to differentiate from other conjunctival disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of unilateral vs. bilateral conditions.
  • Documentation gaps: Incomplete clinical notes regarding the extent of adhesions.
  • Billing challenges: Potential denials due to insufficient evidence of medical necessity.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of H11.213 lies in its potential to affect visual acuity and quality of life for patients. Population health impact may include increased healthcare utilization due to complications arising from untreated adhesions. Quality measures may focus on timely diagnosis and effective management of conjunctival disorders. Understanding the epidemiology of conjunctival adhesions can help healthcare providers identify at-risk populations and implement preventive strategies.

ICD-9 vs ICD-10

The clinical significance of H11.213 lies in its potential to affect visual acuity and quality of life for patients. Population health impact may include increased healthcare utilization due to complications arising from untreated adhesions. Quality measures may focus on timely diagnosis and effective management of conjunctival disorders. Understanding the epidemiology of conjunctival adhesions can help healthcare providers identify at-risk populations and implement preventive strategies.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the medical necessity of the treatment provided, whether it is medical management or surgical intervention. Common denials may arise from insufficient documentation or failure to demonstrate the bilateral nature of the condition. Coders should ensure that all relevant clinical notes, imaging studies, and treatment plans are accurately reflected in the billing documentation to avoid delays in reimbursement.

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 H11.213?

H11.213 specifically covers localized conjunctival adhesions and strands that are bilateral. This includes conditions resulting from chronic inflammation, surgical complications, or trauma that lead to fibrous connections between the conjunctiva and adjacent ocular structures.

When should H11.213 be used instead of related codes?

H11.213 should be used when bilateral conjunctival adhesions are present. If the condition is unilateral, H11.211 should be selected. It is important to document the bilateral nature of the condition clearly to justify the use of this code.

What documentation supports H11.213?

Documentation should include a detailed ocular examination report, findings from slit-lamp biomicroscopy, and any imaging studies that demonstrate the presence and extent of bilateral conjunctival adhesions. Clinical notes should also reflect the patient's symptoms and treatment plan.