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ICD-10 Guide
ICD-10 CodesH11.431

H11.431

Billable

Conjunctival hyperemia, right eye

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

Code Description

ICD-10 H11.431 is a billable code used to indicate a diagnosis of conjunctival hyperemia, right eye.

Key Diagnostic Point:

Conjunctival hyperemia in the right eye is characterized by the dilation of conjunctival blood vessels, leading to a reddened appearance of the eye. This condition can result from various etiologies, including allergic reactions, infections, or irritants. The conjunctiva, a thin membrane covering the sclera and lining the eyelids, plays a crucial role in protecting the eye and maintaining moisture. When inflamed, it can lead to discomfort, tearing, and visual disturbances. Disease progression may vary; acute cases can resolve with appropriate treatment, while chronic hyperemia may indicate underlying conditions such as conjunctivitis or systemic diseases. Diagnostic considerations include a thorough patient history, physical examination, and possibly additional tests like conjunctival swabs or allergy testing to determine the underlying cause. Understanding the anatomy involved—specifically the conjunctiva, sclera, and anterior segment—is essential for accurate diagnosis and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other ocular conditions such as conjunctivitis, episcleritis, or uveitis.
  • Treatment complexity: Management may involve topical antihistamines, corticosteroids, or antibiotics depending on the cause.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise documentation to differentiate from other hyperemia codes.

Audit Risk Factors

  • Common coding errors: Misidentification of the eye affected or incorrect coding of the underlying cause.
  • Documentation gaps: Lack of detailed clinical findings or treatment rationale.
  • Billing challenges: Potential denials if documentation does not clearly 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

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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CPT Code

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Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Conjunctival hyperemia is a common presentation in ophthalmology, impacting a significant portion of the population, particularly those with allergies or exposure to irritants. Understanding and accurately coding this condition is crucial for appropriate management and treatment. Quality measures may include tracking the incidence of conjunctival hyperemia and its resolution rates, which can inform healthcare utilization patterns and guide public health initiatives aimed at reducing ocular irritants in the environment.

ICD-9 vs ICD-10

Conjunctival hyperemia is a common presentation in ophthalmology, impacting a significant portion of the population, particularly those with allergies or exposure to irritants. Understanding and accurately coding this condition is crucial for appropriate management and treatment. Quality measures may include tracking the incidence of conjunctival hyperemia and its resolution rates, which can inform healthcare utilization patterns and guide public health initiatives aimed at reducing ocular irritants in the environment.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the documentation aligns with the services billed, particularly if additional procedures or treatments are provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include maintaining clear clinical notes, ensuring all relevant symptoms and treatments are documented, and regularly reviewing coding guidelines to stay compliant with payer requirements.

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 H11.431?

H11.431 covers conjunctival hyperemia specifically in the right eye, which may be due to allergic conjunctivitis, viral or bacterial infections, or environmental irritants. It is essential to evaluate the patient's history and symptoms to determine the exact cause.

When should H11.431 be used instead of related codes?

H11.431 should be used when the clinical presentation specifically indicates conjunctival hyperemia in the right eye, differentiating it from other conditions such as H11.432 for the left eye or H11.439 for unspecified eye involvement.

What documentation supports H11.431?

Documentation should include a comprehensive eye examination, patient history detailing symptoms, any relevant allergy testing results, and treatment plans. Clear notes on the affected eye and the nature of hyperemia are crucial.