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ICD-10 Guide
ICD-10 CodesH11.31

H11.31

Billable

Conjunctival hemorrhage, right eye

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

Code Description

ICD-10 H11.31 is a billable code used to indicate a diagnosis of conjunctival hemorrhage, right eye.

Key Diagnostic Point:

Conjunctival hemorrhage, specifically in the right eye, refers to the presence of blood in the conjunctival sac, which is the thin membrane covering the white part of the eye and the inner eyelids. Clinically, this condition may present as a bright red patch on the sclera, often without associated pain or visual disturbance. The conjunctiva is highly vascular, and hemorrhage can occur due to various factors such as trauma, increased venous pressure, or systemic conditions like hypertension. The disease progression is typically benign, with most cases resolving spontaneously within one to two weeks. Diagnostic considerations include a thorough history and physical examination to rule out underlying causes such as bleeding disorders or systemic diseases. It is essential to differentiate conjunctival hemorrhage from other ocular conditions, such as scleral or corneal injuries, which may require more urgent intervention. Anterior segment disorders may also be evaluated to ensure no concurrent issues are present, such as uveitis or keratitis, which could complicate the clinical picture.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Diagnostic complexity: Low; typically straightforward diagnosis based on clinical presentation.
  • Treatment complexity: Low; most cases resolve spontaneously without intervention.
  • Documentation requirements: Moderate; requires clear documentation of findings and any underlying conditions.
  • Coding specificity: High; specific to conjunctival hemorrhage in the right eye.

Audit Risk Factors

  • Common coding errors: Misidentifying the eye involved or confusing with other hemorrhagic conditions.
  • Documentation gaps: Lack of detailed history or examination findings may lead to coding inaccuracies.
  • Billing challenges: Potential denials if the condition is not well-documented or if associated conditions are not addressed.

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

Primary Care

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Conjunctival hemorrhage is a common condition that can affect individuals across various demographics, often leading to unnecessary anxiety for patients. Understanding its benign nature can help reduce healthcare utilization, as many cases do not require extensive intervention. The condition's prevalence highlights the importance of education for both healthcare providers and patients regarding its self-limiting nature, thereby improving quality measures and patient satisfaction.

ICD-9 vs ICD-10

Conjunctival hemorrhage is a common condition that can affect individuals across various demographics, often leading to unnecessary anxiety for patients. Understanding its benign nature can help reduce healthcare utilization, as many cases do not require extensive intervention. The condition's prevalence highlights the importance of education for both healthcare providers and patients regarding its self-limiting nature, thereby improving quality measures and patient satisfaction.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, but generally, clear documentation of the clinical findings and any relevant history will support claims. Common denials may arise from insufficient documentation or failure to specify the eye involved. Best practices include using precise language in documentation and ensuring that all relevant clinical details are included 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 H11.31?

H11.31 specifically covers isolated conjunctival hemorrhage in the right eye, which may occur due to trauma, systemic hypertension, or other benign causes. It does not include hemorrhages associated with other ocular conditions such as uveitis or retinal hemorrhages.

When should H11.31 be used instead of related codes?

H11.31 should be used when the clinical presentation is limited to conjunctival hemorrhage in the right eye without additional complications or when differentiating from left eye or bilateral conditions.

What documentation supports H11.31?

Documentation should include a detailed ocular examination, noting the presence of hemorrhage, any associated symptoms, and a review of the patient's medical history to identify potential underlying causes.