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ICD-10 Guide
ICD-10 CodesH11.249

H11.249

Billable

Scarring of conjunctiva, unspecified eye

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

Code Description

ICD-10 H11.249 is a billable code used to indicate a diagnosis of scarring of conjunctiva, unspecified eye.

Key Diagnostic Point:

Scarring of the conjunctiva, unspecified eye, refers to the pathological alteration of the conjunctival tissue characterized by fibrous tissue formation, which can result from various etiologies including trauma, infection, or chronic inflammation. The conjunctiva is a thin, transparent membrane that covers the sclera and lines the eyelids, playing a crucial role in protecting the eye and maintaining ocular surface health. Clinically, patients may present with symptoms such as redness, irritation, discomfort, and visual disturbances. Disease progression can lead to complications such as dry eye syndrome, reduced visual acuity, or even corneal damage if left untreated. Diagnostic considerations include a thorough ocular examination, patient history, and possibly imaging studies to assess the extent of scarring and rule out associated conditions. Management may involve topical medications, surgical intervention, or referral to an ophthalmologist for specialized care, depending on the severity and underlying cause of the scarring.

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

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 scarring of the conjunctiva is notable, as it can lead to discomfort and visual impairment, affecting the quality of life for patients. In terms of population health, understanding the prevalence of conjunctival scarring can help in developing preventive strategies and improving treatment protocols. Quality measures may include monitoring the outcomes of treatments for conjunctival scarring, which can influence healthcare utilization patterns and resource allocation in ophthalmology.

ICD-9 vs ICD-10

The clinical significance of scarring of the conjunctiva is notable, as it can lead to discomfort and visual impairment, affecting the quality of life for patients. In terms of population health, understanding the prevalence of conjunctival scarring can help in developing preventive strategies and improving treatment protocols. Quality measures may include monitoring the outcomes of treatments for conjunctival scarring, which can influence healthcare utilization patterns and resource allocation in ophthalmology.

Reimbursement & Billing Impact

Reimbursement may vary based on the payer's policies, so understanding the specific requirements for documentation and coding is essential. Common denials may arise from insufficient documentation or failure to demonstrate the medical necessity of the services rendered. Best practices include maintaining clear and concise records, using appropriate modifiers when necessary, and ensuring that all services are coded accurately to reflect the patient's condition.

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 H11.249?

H11.249 encompasses various conditions leading to conjunctival scarring, including chemical burns, chronic conjunctivitis, and post-surgical changes. It is essential to document the underlying cause to support the diagnosis.

When should H11.249 be used instead of related codes?

H11.249 should be used when the specific eye affected is not documented, or when the scarring is bilateral and not specified. If the eye is specified, use H11.248 or H11.247 accordingly.

What documentation supports H11.249?

Documentation should include a detailed patient history, clinical findings, and any diagnostic tests performed. Descriptions of the extent and nature of the scarring, as well as treatment plans, are critical for supporting the use of this code.