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ICD-10 Guide
ICD-10 CodesH11.232

H11.232

Billable

Symblepharon, left eye

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

Code Description

ICD-10 H11.232 is a billable code used to indicate a diagnosis of symblepharon, left eye.

Key Diagnostic Point:

Symblepharon is a condition characterized by the adhesion of the conjunctiva of the eyelid to the bulbar conjunctiva of the eyeball, which can occur in the left eye as denoted by H11.232. This condition may arise from various etiologies, including trauma, chemical burns, infections, or surgical complications, leading to significant anatomical and functional implications. The conjunctiva, sclera, and cornea are crucial structures involved in maintaining ocular health and vision. Symblepharon can disrupt the normal movement of the eyelids, affecting tear distribution and leading to dryness, irritation, and potential corneal damage. Disease progression may vary, with some patients experiencing mild symptoms while others may develop severe complications, including vision impairment. Diagnostic considerations include a thorough ocular examination, patient history, and possibly imaging studies to assess the extent of adhesion and any associated ocular surface disease. Treatment often involves surgical intervention to release the adhesion and restore normal eyelid function, along with addressing any underlying causes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful assessment of ocular structures and potential underlying causes.
  • Treatment complexity: Surgical intervention may be necessary, with varying degrees of success.
  • Documentation requirements: Detailed clinical notes are essential to justify the diagnosis and treatment.
  • Coding specificity: Requires precise coding to differentiate from other conjunctival disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of the eye involved or confusion with other conjunctival conditions.
  • Documentation gaps: Incomplete clinical notes that do not adequately describe the condition or treatment.
  • Billing challenges: Potential denials related to insufficient evidence of medical necessity for surgical procedures.

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

Plastic Surgery

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

Symblepharon can significantly impact a patient's quality of life by affecting vision and ocular comfort. The condition may lead to increased healthcare utilization due to complications such as corneal damage or chronic irritation. Understanding the epidemiology of symblepharon, including its prevalence in post-traumatic cases or following ocular surgeries, can inform preventive strategies and improve patient outcomes. Quality measures may include tracking surgical success rates and patient-reported outcomes related to ocular health.

ICD-9 vs ICD-10

Symblepharon can significantly impact a patient's quality of life by affecting vision and ocular comfort. The condition may lead to increased healthcare utilization due to complications such as corneal damage or chronic irritation. Understanding the epidemiology of symblepharon, including its prevalence in post-traumatic cases or following ocular surgeries, can inform preventive strategies and improve patient outcomes. Quality measures may include tracking surgical success rates and patient-reported outcomes related to ocular health.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the medical necessity for surgical interventions, which may involve prior authorization. Common denials can occur if the documentation does not clearly establish the need for surgery or if the procedure is not appropriately linked to the diagnosis. Best practices include maintaining thorough clinical notes, obtaining consent for procedures, and ensuring that all coding aligns with the services rendered.

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 H11.232?

H11.232 specifically covers symblepharon of the left eye, which can result from various conditions such as trauma, chemical burns, or infections that lead to conjunctival adhesion. It is important to differentiate this from other conjunctival disorders like conjunctivitis or pterygium.

When should H11.232 be used instead of related codes?

H11.232 should be used when the clinical findings specifically indicate symblepharon in the left eye. If the condition affects the right eye, H11.231 should be used. Accurate documentation of the affected eye and the nature of the adhesion is crucial for appropriate code selection.

What documentation supports H11.232?

Documentation should include a detailed ocular examination report, patient history indicating the onset and cause of symblepharon, treatment plans, and any surgical notes if applicable. Photographic evidence may also support the diagnosis.