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ICD-10 Guide
ICD-10 CodesH11.239

H11.239

Billable

Symblepharon, unspecified eye

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

Code Description

ICD-10 H11.239 is a billable code used to indicate a diagnosis of symblepharon, unspecified eye.

Key Diagnostic Point:

Symblepharon is a condition characterized by the adhesion of the eyelid to the eyeball, which can occur due to various causes including trauma, inflammation, or surgical complications. The clinical presentation may include restricted eye movement, discomfort, and visual disturbances, depending on the extent of the adhesion. The anatomy involved primarily includes the conjunctiva, sclera, and cornea, as the adhesion typically forms between the palpebral conjunctiva of the eyelid and the bulbar conjunctiva of the eye. Disease progression can lead to complications such as dry eye syndrome, corneal exposure, and potential vision loss if left untreated. Diagnostic considerations include a thorough ocular examination, patient history, and imaging studies if necessary to assess the extent of the symblepharon and any associated ocular surface disorders. Treatment options may vary from conservative management to surgical intervention, depending on the severity and impact on the patient's quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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 affect a patient's quality of life by impairing vision and causing discomfort. Understanding its prevalence and impact on population health is essential for developing effective treatment protocols. Quality measures may include tracking the outcomes of surgical interventions and patient satisfaction. Epidemiologically, the condition may be more prevalent in populations with higher rates of ocular trauma or inflammatory diseases.

ICD-9 vs ICD-10

Symblepharon can significantly affect a patient's quality of life by impairing vision and causing discomfort. Understanding its prevalence and impact on population health is essential for developing effective treatment protocols. Quality measures may include tracking the outcomes of surgical interventions and patient satisfaction. Epidemiologically, the condition may be more prevalent in populations with higher rates of ocular trauma or inflammatory diseases.

Reimbursement & Billing Impact

reimbursement issues. It is crucial to provide clear justification for the use of the unspecified code and to follow payer-specific guidelines for claims submission.

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 H11.239?

H11.239 covers cases of symblepharon where the specific eye involved is not documented. It may include congenital symblepharon, post-surgical adhesions, or those resulting from inflammatory conditions. Diagnostic criteria typically involve clinical examination findings of eyelid and conjunctival adhesion.

When should H11.239 be used instead of related codes?

H11.239 should be used when the specific eye affected by symblepharon is not documented or when the condition is generalized without further specification. If the condition is localized to one eye, the specific codes H11.238 or H11.240 should be utilized.

What documentation supports H11.239?

Documentation should include a detailed ocular examination report, patient history indicating the onset and progression of symptoms, and any imaging studies that may support the diagnosis of symblepharon. Clear notes on the treatment plan and patient response are also essential.