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ICD-10 Guide
ICD-10 CodesH11.419

H11.419

Billable

Vascular abnormalities of conjunctiva, unspecified eye

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

Code Description

ICD-10 H11.419 is a billable code used to indicate a diagnosis of vascular abnormalities of conjunctiva, unspecified eye.

Key Diagnostic Point:

H11.419 refers to vascular abnormalities of the conjunctiva in an unspecified eye, which can manifest as various conditions affecting the conjunctival tissue. The conjunctiva is a thin, transparent membrane that covers the white part of the eyeball (sclera) and lines the inside of the eyelids. Vascular abnormalities may include conditions such as conjunctival varices, hemangiomas, or other vascular malformations that can lead to symptoms like redness, swelling, or irritation. These abnormalities can be congenital or acquired and may progress to cause discomfort or visual disturbances if left untreated. Diagnosis typically involves a thorough ocular examination, including slit-lamp evaluation, and may require imaging studies to assess the extent of the vascular involvement. Treatment options vary based on the severity and type of abnormality, ranging from observation to surgical intervention. Understanding the anatomy of the conjunctiva and its vascular supply is crucial for accurate diagnosis and management of these conditions.

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 H11.419 lies in its potential to affect patient comfort and visual function. Vascular abnormalities of the conjunctiva can lead to complications if not addressed, impacting overall eye health. Understanding the epidemiology of these conditions can help healthcare providers identify at-risk populations and implement preventive measures, ultimately improving patient outcomes and reducing healthcare utilization.

ICD-9 vs ICD-10

The clinical significance of H11.419 lies in its potential to affect patient comfort and visual function. Vascular abnormalities of the conjunctiva can lead to complications if not addressed, impacting overall eye health. Understanding the epidemiology of these conditions can help healthcare providers identify at-risk populations and implement preventive measures, ultimately improving patient outcomes and reducing healthcare utilization.

Reimbursement & Billing Impact

Reimbursement may vary based on the payer and the complexity of the case. Common denials can occur if the documentation does not clearly establish the medical necessity for the services provided. Coders should ensure that all relevant clinical information is included in the patient's record to justify the use of this code and any associated CPT codes for procedures performed.

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 H11.419?

H11.419 encompasses various vascular abnormalities of the conjunctiva, including conjunctival varices, hemangiomas, and other vascular malformations that do not have a specified eye involvement. Diagnosis may require imaging or biopsy to differentiate from other conjunctival lesions.

When should H11.419 be used instead of related codes?

H11.419 should be used when the specific eye affected is not documented or when the condition is bilateral but not specified. If the condition is clearly documented as affecting one eye, the specific codes H11.41 or H11.42 should be utilized.

What documentation supports H11.419?

Documentation should include a detailed ocular examination report, noting symptoms, visual acuity, and any imaging studies performed. Clear identification of the condition and its impact on the patient’s health is essential for appropriate coding.