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ICD-10 Guide
ICD-10 CodesH11.243

H11.243

Billable

Scarring of conjunctiva, bilateral

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

Code Description

ICD-10 H11.243 is a billable code used to indicate a diagnosis of scarring of conjunctiva, bilateral.

Key Diagnostic Point:

Scarring of the conjunctiva, bilateral, refers to the pathological alteration of the conjunctival tissue characterized by fibrous tissue formation that can result from various underlying conditions such as chronic inflammation, trauma, or chemical burns. The conjunctiva is a thin, transparent membrane that covers the white part of the eyeball (sclera) and lines the inside of the eyelids. Scarring can lead to symptoms such as irritation, redness, and discomfort, and may also affect vision if the scarring is extensive. Disease progression can vary; in some cases, it may remain stable, while in others, it can lead to complications such as symblepharon (adhesion of the conjunctiva to the eyelid) or dry eye syndrome due to impaired tear film stability. Diagnostic considerations include a thorough ocular examination, patient history, and possibly imaging studies to assess the extent of scarring and any associated conditions affecting the sclera or cornea. Treatment may involve lubricating eye drops, corticosteroids, or surgical intervention depending on the severity and impact on vision.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive ocular examination and history-taking.
  • Treatment complexity: May involve multiple treatment modalities including medical and surgical options.
  • Documentation requirements: Detailed documentation of symptoms, examination findings, and treatment plans is necessary.
  • Coding specificity: Requires accurate coding to differentiate from other conjunctival disorders.

Audit Risk Factors

  • Common coding errors: Misidentification of unilateral vs bilateral scarring.
  • Documentation gaps: Incomplete records regarding the extent of scarring and associated symptoms.
  • Billing challenges: Potential for denials if documentation does not clearly support the diagnosis and treatment provided.

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 H11.243 lies in its potential to affect a patient's quality of life through discomfort and vision impairment. Understanding the epidemiology of conjunctival scarring can help healthcare providers identify at-risk populations, such as those with a history of ocular trauma or chronic inflammatory conditions. Quality measures may include monitoring treatment outcomes and patient-reported symptoms, which can inform healthcare utilization patterns and improve overall patient care.

ICD-9 vs ICD-10

The clinical significance of H11.243 lies in its potential to affect a patient's quality of life through discomfort and vision impairment. Understanding the epidemiology of conjunctival scarring can help healthcare providers identify at-risk populations, such as those with a history of ocular trauma or chronic inflammatory conditions. Quality measures may include monitoring treatment outcomes and patient-reported symptoms, which can inform healthcare utilization patterns and improve overall patient care.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for ophthalmic services and ensuring that the procedure codes align with the diagnosis. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the treatment provided. Best practices include maintaining thorough records of patient interactions, treatment plans, and follow-up care to support claims and reduce the likelihood of audits.

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 H11.243?

H11.243 covers bilateral scarring of the conjunctiva resulting from conditions such as chronic conjunctivitis, chemical injuries, or surgical trauma. It is important to document the underlying cause to support the diagnosis.

When should H11.243 be used instead of related codes?

H11.243 should be used when there is documented bilateral conjunctival scarring. If the scarring is unilateral, H11.242 should be selected. Accurate documentation of the clinical findings is essential for proper code selection.

What documentation supports H11.243?

Documentation should include a detailed ocular examination report, patient history indicating the cause of scarring, symptoms experienced by the patient, and any treatment plans or interventions undertaken.