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ICD-10 Guide
ICD-10 CodesH11.223

H11.223

Billable

Conjunctival granuloma, bilateral

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

Code Description

ICD-10 H11.223 is a billable code used to indicate a diagnosis of conjunctival granuloma, bilateral.

Key Diagnostic Point:

Conjunctival granuloma, bilateral, is characterized by the formation of localized inflammatory lesions on the conjunctiva, the thin membrane covering the white part of the eye and the inner eyelids. Clinically, patients may present with symptoms such as redness, swelling, irritation, and discomfort in both eyes. The condition can arise from various etiologies, including chronic inflammation, foreign body reactions, or infections. The conjunctiva is composed of epithelial and connective tissue, and granulomas typically develop as a response to persistent irritants or infections. Disease progression can lead to complications such as scarring or vision impairment if left untreated. Diagnostic considerations include a thorough patient history, physical examination, and possibly biopsy to differentiate conjunctival granuloma from other conjunctival lesions, such as papillomas or neoplasms. Management often involves addressing the underlying cause, which may include corticosteroids or surgical intervention for larger granulomas.

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 misidentifying the condition as a neoplasm or other conjunctival disorder.
  • Documentation gaps may arise if the underlying cause is not clearly stated.
  • Billing challenges can occur if the treatment plan is not well-documented or if the condition is not adequately 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

Allergy and Immunology

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 H11.223 lies in its potential to affect visual health and quality of life for patients. Understanding the epidemiology of conjunctival granulomas can inform healthcare providers about population health trends and the need for targeted interventions. Quality measures may include tracking the incidence of conjunctival granulomas and ensuring timely diagnosis and treatment to prevent complications. Healthcare utilization patterns may reflect the need for increased ophthalmology consultations and potential surgical interventions.

ICD-9 vs ICD-10

The clinical significance of H11.223 lies in its potential to affect visual health and quality of life for patients. Understanding the epidemiology of conjunctival granulomas can inform healthcare providers about population health trends and the need for targeted interventions. Quality measures may include tracking the incidence of conjunctival granulomas and ensuring timely diagnosis and treatment to prevent complications. Healthcare utilization patterns may reflect the need for increased ophthalmology consultations and potential surgical interventions.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the treatment plan aligns with the diagnosis, as well as providing evidence of medical necessity for any procedures performed. Common denials may occur if documentation does not sufficiently support the diagnosis or if the treatment is deemed not medically necessary. Coding best practices include using the most specific code available and ensuring that all relevant clinical information is included in the patient's medical record.

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 H11.223?

H11.223 specifically covers bilateral conjunctival granulomas, which may arise from chronic irritation, infections, or foreign body reactions. It is essential to differentiate this condition from other conjunctival disorders such as conjunctivitis or neoplasms.

When should H11.223 be used instead of related codes?

H11.223 should be used when bilateral conjunctival granulomas are diagnosed, particularly when symptoms and clinical findings are present in both eyes. It is crucial to differentiate it from unilateral conditions or other conjunctival lesions.

What documentation supports H11.223?

Documentation should include a detailed patient history, clinical examination findings, and any diagnostic tests performed. A clear description of the bilateral nature of the granulomas and the underlying causes should be documented to support the use of H11.223.