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ICD-10 Guide
ICD-10 CodesH11.221

H11.221

Billable

Conjunctival granuloma, right eye

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

Code Description

ICD-10 H11.221 is a billable code used to indicate a diagnosis of conjunctival granuloma, right eye.

Key Diagnostic Point:

Conjunctival granuloma, specifically in the right eye, is characterized by a localized inflammatory response in the conjunctiva, often presenting as a raised, red lesion. The conjunctiva is the thin, transparent membrane covering the white part of the eyeball and the inner surface of the eyelids. Granulomas can arise due to various etiologies, including foreign body reactions, infections, or autoimmune processes. Clinically, patients may present with symptoms such as irritation, redness, and occasionally, discharge. The disease progression can vary; while some granulomas may resolve spontaneously, others may persist or enlarge, necessitating intervention. Diagnostic considerations include a thorough ocular examination, patient history, and possibly imaging or biopsy to rule out malignancy or other underlying conditions. The anterior segment of the eye, which includes the cornea and sclera, may also be affected indirectly due to the inflammatory process, leading to potential complications if left untreated.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differential diagnosis to exclude other conjunctival lesions.
  • Treatment complexity: May involve topical medications, surgical excision, or corticosteroid injections.
  • Documentation requirements: Detailed clinical notes and possibly imaging results are necessary.
  • Coding specificity: Requires precise coding to differentiate from other conjunctival disorders.

Audit Risk Factors

  • Common coding errors: Misclassification with other conjunctival conditions.
  • Documentation gaps: Lack of detailed clinical findings or treatment plans.
  • Billing challenges: Potential denials if documentation does not support the diagnosis.

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

Pathology

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 granulomas, while often benign, can significantly impact patient quality of life due to discomfort and potential vision impairment. Understanding the epidemiology of conjunctival disorders is crucial for public health, as these conditions can indicate underlying systemic issues. Effective management and documentation can improve healthcare utilization patterns and contribute to better quality measures in ophthalmic care.

ICD-9 vs ICD-10

Conjunctival granulomas, while often benign, can significantly impact patient quality of life due to discomfort and potential vision impairment. Understanding the epidemiology of conjunctival disorders is crucial for public health, as these conditions can indicate underlying systemic issues. Effective management and documentation can improve healthcare utilization patterns and contribute to better quality measures in ophthalmic care.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is well-supported by the medical record. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures performed. Best practices include maintaining clear and concise clinical notes, using appropriate modifiers when necessary, and ensuring that all services rendered are justified by the diagnosis.

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 H11.221?

H11.221 specifically covers conjunctival granulomas, which may arise from foreign body reactions, infections, or autoimmune conditions. It does not cover other conjunctival lesions such as cysts or tumors.

When should H11.221 be used instead of related codes?

H11.221 should be used when a patient presents with a granulomatous lesion on the conjunctiva of the right eye, particularly when the lesion is confirmed through clinical examination and possibly biopsy, differentiating it from other conjunctival disorders.

What documentation supports H11.221?

Documentation should include a detailed ocular examination, patient history indicating the onset and symptoms of the granuloma, and any diagnostic imaging or biopsy results that confirm the diagnosis.