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ICD-10 Guide
ICD-10 CodesH11.422

H11.422

Billable

Conjunctival edema, left eye

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

Code Description

ICD-10 H11.422 is a billable code used to indicate a diagnosis of conjunctival edema, left eye.

Key Diagnostic Point:

Conjunctival edema in the left eye, classified under ICD-10 code H11.422, refers to the swelling of the conjunctiva, the clear membrane covering the white part of the eye and the inner eyelids. This condition can arise from various etiologies, including allergic reactions, infections, trauma, or systemic conditions. Clinically, patients may present with symptoms such as redness, discomfort, tearing, and visual disturbances. The conjunctiva is a critical component of the anterior segment of the eye, which also includes the sclera and cornea. In cases of conjunctival edema, the underlying cause must be identified to determine the appropriate treatment. Diagnostic considerations may involve a thorough patient history, slit-lamp examination, and possibly laboratory tests to rule out infections or allergies. Disease progression can vary; if left untreated, conjunctival edema may lead to complications such as secondary infections or chronic irritation. Therefore, timely diagnosis and management are essential to prevent further ocular issues.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other ocular conditions such as conjunctivitis or keratitis.
  • Treatment complexity: May involve topical antihistamines, corticosteroids, or addressing underlying systemic issues.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to specify the affected eye and the nature of the edema.

Audit Risk Factors

  • Common coding errors: Misidentifying the affected eye or failing to document the cause of edema.
  • Documentation gaps: Incomplete patient history or lack of diagnostic tests can lead to coding inaccuracies.
  • Billing challenges: Potential denials if the medical necessity is not clearly established in the documentation.

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

Allergy and Immunology

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

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Documentation Requirements

CPT Code

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CPT Code

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Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Conjunctival edema can significantly affect patient quality of life, leading to discomfort and visual disturbances. Understanding its prevalence and impact on population health is essential for healthcare providers. Effective management can reduce healthcare utilization patterns, such as unnecessary visits to emergency departments for eye-related complaints. Epidemiologically, conditions leading to conjunctival edema, such as allergies, are common, making awareness and proper coding vital for tracking and managing these conditions in the healthcare system.

ICD-9 vs ICD-10

Conjunctival edema can significantly affect patient quality of life, leading to discomfort and visual disturbances. Understanding its prevalence and impact on population health is essential for healthcare providers. Effective management can reduce healthcare utilization patterns, such as unnecessary visits to emergency departments for eye-related complaints. Epidemiologically, conditions leading to conjunctival edema, such as allergies, are common, making awareness and proper coding vital for tracking and managing these conditions in the healthcare system.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the medical necessity for the visit and any procedures performed is clearly documented. Common denials may arise from insufficient documentation or failure to link the diagnosis to the treatment provided. Best practices include maintaining thorough clinical notes, ensuring that all relevant tests and treatments are documented, and verifying that the coding accurately reflects the clinical findings.

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 H11.422?

H11.422 covers conjunctival edema specifically in the left eye, which can be due to allergic reactions, infections, or trauma. It is important to document the underlying cause to ensure accurate coding and treatment.

When should H11.422 be used instead of related codes?

H11.422 should be used when the edema is specifically localized to the left eye. If the edema is bilateral or affects the right eye, other codes such as H11.421 or H11.429 should be considered.

What documentation supports H11.422?

Documentation should include a detailed patient history, clinical findings from an eye examination, and any diagnostic tests performed. Evidence of the underlying cause of edema is crucial for supporting the diagnosis.