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ICD-10 Guide
ICD-10 CodesH11.233

H11.233

Billable

Symblepharon, bilateral

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

Code Description

ICD-10 H11.233 is a billable code used to indicate a diagnosis of symblepharon, bilateral.

Key Diagnostic Point:

Symblepharon, bilateral, is a condition characterized by the abnormal adhesion of the conjunctiva to the eyeball or eyelid, resulting in a partial or complete fusion of these structures. This condition can arise from various causes, including trauma, chemical burns, infections, or inflammatory diseases affecting the conjunctiva. The clinical presentation may include restricted eye movement, discomfort, and visual disturbances due to corneal exposure or scarring. The anatomy involved primarily includes the conjunctiva, sclera, and cornea, with potential implications for the anterior segment of the eye. Disease progression can lead to complications such as corneal opacity, chronic inflammation, and even vision loss if left untreated. Diagnostic considerations include a thorough ocular examination, history of prior ocular trauma or surgery, and imaging studies if necessary to assess the extent of adhesion. Management typically involves surgical intervention to separate the adhered tissues and restore normal eyelid function, alongside addressing any underlying causes.

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 unilateral.
  • Documentation gaps may arise if the extent of adhesion is not clearly described.
  • Billing challenges can occur if the surgical procedure is not adequately supported by clinical documentation.

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

The clinical significance of H11.233 lies in its potential to affect visual acuity and quality of life due to discomfort and restricted eye movement. Population health impact includes the need for timely intervention to prevent complications such as corneal scarring. Quality measures may focus on the timely diagnosis and treatment of symblepharon to improve patient outcomes. Healthcare utilization patterns may show increased visits to ophthalmology for surgical management, highlighting the importance of awareness and early intervention in affected populations.

ICD-9 vs ICD-10

The clinical significance of H11.233 lies in its potential to affect visual acuity and quality of life due to discomfort and restricted eye movement. Population health impact includes the need for timely intervention to prevent complications such as corneal scarring. Quality measures may focus on the timely diagnosis and treatment of symblepharon to improve patient outcomes. Healthcare utilization patterns may show increased visits to ophthalmology for surgical management, highlighting the importance of awareness and early intervention in affected populations.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the medical necessity of the procedure and ensuring that all relevant clinical information is included in the claim. Common denials may arise from insufficient documentation or failure to demonstrate the need for surgical intervention. Coding best practices recommend using precise language in documentation to support the diagnosis and treatment provided.

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 H11.233?

H11.233 covers bilateral symblepharon, which may result from trauma, chemical burns, or chronic inflammatory conditions affecting the conjunctiva. It is essential to differentiate this from other conjunctival disorders.

When should H11.233 be used instead of related codes?

H11.233 should be used when bilateral symblepharon is diagnosed, particularly when both eyes are affected, as opposed to unilateral cases which would use H11.232.

What documentation supports H11.233?

Documentation should include a detailed ocular examination, history of prior ocular trauma or surgery, and any imaging studies that demonstrate the extent of the symblepharon.