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ICD-10 Guide
ICD-10 CodesH11.242

H11.242

Billable

Scarring of conjunctiva, left eye

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

Code Description

ICD-10 H11.242 is a billable code used to indicate a diagnosis of scarring of conjunctiva, left eye.

Key Diagnostic Point:

H11.242 refers to scarring of the conjunctiva in the left eye, a condition that can arise from various etiologies including trauma, chronic inflammation, or surgical intervention. The conjunctiva is a thin, transparent membrane that covers the white part of the eyeball and lines the inside of the eyelids. Scarring can lead to discomfort, visual disturbances, and may affect the overall health of the ocular surface. Clinically, patients may present with symptoms such as redness, irritation, and foreign body sensation. The progression of conjunctival scarring can lead to complications such as symblepharon (adhesion of the conjunctiva to the eyelid) or keratoconjunctivitis. Diagnostic considerations include a thorough ocular examination, slit-lamp biomicroscopy, and possibly imaging studies to assess the extent of scarring. Treatment may involve lubricating eye drops, corticosteroids to reduce inflammation, or surgical intervention to repair the conjunctiva. Accurate diagnosis and coding are essential for appropriate management and reimbursement.

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 affected eye or failing to document the cause of scarring.
  • Documentation gaps may arise if the underlying condition leading to scarring is not clearly stated.
  • Billing challenges can occur if the treatment plan is not adequately supported by clinical evidence.

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

Optometry

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of H11.242 lies in its potential to affect visual acuity and quality of life for patients. Population health impact includes the need for ongoing management of ocular surface disorders, which can lead to increased healthcare utilization. Quality measures may focus on timely diagnosis and effective treatment of conjunctival scarring, while epidemiological considerations highlight the prevalence of conditions leading to conjunctival scarring, such as allergies and environmental exposures.

ICD-9 vs ICD-10

The clinical significance of H11.242 lies in its potential to affect visual acuity and quality of life for patients. Population health impact includes the need for ongoing management of ocular surface disorders, which can lead to increased healthcare utilization. Quality measures may focus on timely diagnosis and effective treatment of conjunctival scarring, while epidemiological considerations highlight the prevalence of conditions leading to conjunctival scarring, such as allergies and environmental exposures.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the condition and the necessity of any surgical interventions. Common denials may arise from insufficient documentation or lack of clarity regarding the cause of scarring. It is crucial to ensure that all relevant clinical findings are recorded and that the coding accurately reflects the patient's condition to avoid billing challenges.

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 H11.242?

H11.242 encompasses conditions leading to conjunctival scarring such as chemical burns, chronic conjunctivitis, and post-surgical changes. It is important to document the underlying cause for accurate coding.

When should H11.242 be used instead of related codes?

H11.242 should be used when scarring is specifically noted in the left eye. If the right eye is affected, H11.241 should be used. If both eyes are involved, additional codes may be necessary.

What documentation supports H11.242?

Documentation should include a detailed ocular examination, findings from slit-lamp examination, and any relevant history of trauma or surgery. Clear descriptions of symptoms and treatment plans are also essential.