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ICD-10 Guide
ICD-10 CodesH11.413

H11.413

Billable

Vascular abnormalities of conjunctiva, bilateral

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

Code Description

ICD-10 H11.413 is a billable code used to indicate a diagnosis of vascular abnormalities of conjunctiva, bilateral.

Key Diagnostic Point:

H11.413 refers to vascular abnormalities of the conjunctiva, specifically affecting both eyes. These abnormalities can manifest as conjunctival hyperemia, varicosities, or other vascular lesions that may lead to discomfort, visual disturbances, or cosmetic concerns. The conjunctiva is a thin, transparent membrane covering the sclera and lining the eyelids, playing a crucial role in eye protection and lubrication. Vascular abnormalities can arise from various etiologies, including chronic inflammation, trauma, or systemic vascular disorders. Disease progression may vary; some patients may experience stable conditions, while others may develop complications such as conjunctival scarring or secondary infections. Diagnostic considerations include a thorough ocular examination, possibly supplemented by imaging techniques like ultrasound biomicroscopy to assess the extent of vascular changes. Clinicians should differentiate these conditions from other conjunctival disorders, such as conjunctival cysts or tumors, to ensure accurate diagnosis and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough examination and possible imaging.
  • Treatment complexity: May involve medical management or surgical intervention.
  • Documentation requirements: Detailed clinical notes and imaging results are essential.
  • Coding specificity: Requires precise coding to differentiate from similar conditions.

Audit Risk Factors

  • Common coding errors: Misidentification of unilateral vs. bilateral conditions.
  • Documentation gaps: Incomplete clinical notes may lead to incorrect coding.
  • Billing challenges: Potential for denials if documentation does not support the diagnosis.

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 H11.413 lies in its potential to affect patient quality of life due to discomfort or cosmetic concerns. Population health impact may include increased healthcare utilization for diagnosis and treatment. Quality measures may focus on timely diagnosis and effective management of ocular conditions. Epidemiologically, understanding the prevalence of conjunctival vascular abnormalities can aid in identifying at-risk populations and improving overall eye health outcomes.

ICD-9 vs ICD-10

The clinical significance of H11.413 lies in its potential to affect patient quality of life due to discomfort or cosmetic concerns. Population health impact may include increased healthcare utilization for diagnosis and treatment. Quality measures may focus on timely diagnosis and effective management of ocular conditions. Epidemiologically, understanding the prevalence of conjunctival vascular abnormalities can aid in identifying at-risk populations and improving overall eye health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the medical necessity for any procedures or treatments is clearly documented. Common denials may arise from insufficient documentation or failure to provide evidence of the bilateral nature of the condition. Best practices include maintaining thorough clinical notes, using appropriate modifiers when necessary, and ensuring that all services rendered are justified by the patient's clinical presentation.

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 H11.413?

H11.413 encompasses various vascular abnormalities of the conjunctiva, including conjunctival varices, hyperemia, and other vascular lesions that affect both eyes. These conditions may be associated with systemic diseases or localized factors.

When should H11.413 be used instead of related codes?

H11.413 should be used when bilateral conjunctival vascular abnormalities are diagnosed. If the condition is unilateral, H11.412 should be selected. Accurate differentiation is crucial for proper coding and treatment planning.

What documentation supports H11.413?

Documentation should include a comprehensive ocular examination report, details of the clinical presentation, any imaging studies performed, and a treatment plan. Clear notes on the bilateral nature of the condition are essential.