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ICD-10 Guide
ICD-10 CodesH11.443

H11.443

Billable

Conjunctival cysts, bilateral

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

Code Description

ICD-10 H11.443 is a billable code used to indicate a diagnosis of conjunctival cysts, bilateral.

Key Diagnostic Point:

Conjunctival cysts, bilateral, are benign lesions that form on the conjunctiva, the clear membrane covering the white part of the eye and the inner eyelids. These cysts can arise due to various factors, including obstruction of the conjunctival glands, trauma, or chronic irritation. Clinically, patients may present with asymptomatic, translucent nodules that can vary in size. While bilateral conjunctival cysts are not uncommon, they may indicate underlying systemic conditions or environmental factors contributing to their formation. The anatomy involved includes the conjunctiva, which is richly supplied with blood vessels and nerves, making it sensitive to irritation and inflammation. Disease progression is typically slow, and while these cysts are generally harmless, they can become symptomatic if they grow large enough to cause discomfort or visual obstruction. Diagnostic considerations include a thorough ocular examination, and in some cases, imaging may be warranted to rule out other conjunctival or orbital pathologies. A definitive diagnosis is often made based on clinical appearance and patient history.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as differentiation from other conjunctival lesions may require careful examination.
  • Treatment complexity: Low, as treatment is often conservative, but surgical intervention may be needed for symptomatic cases.
  • Documentation requirements: Moderate, necessitating detailed descriptions of the cysts and any associated symptoms.
  • Coding specificity: High, as the code specifically denotes bilateral conjunctival cysts.

Audit Risk Factors

  • Common coding errors: Misidentification of the cysts as other conjunctival lesions.
  • Documentation gaps: Lack of detailed clinical notes regarding the size, symptoms, and treatment plan.
  • Billing challenges: Potential denials if the medical necessity for treatment is not clearly documented.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Conjunctival cysts, while generally benign, can affect patient quality of life if they cause discomfort or visual disturbances. Understanding the epidemiology of conjunctival cysts can help healthcare providers identify at-risk populations and implement preventive measures. Monitoring the prevalence of these cysts contributes to population health data, guiding resource allocation and healthcare utilization patterns. Quality measures may include tracking patient outcomes following treatment for conjunctival cysts.

ICD-9 vs ICD-10

Conjunctival cysts, while generally benign, can affect patient quality of life if they cause discomfort or visual disturbances. Understanding the epidemiology of conjunctival cysts can help healthcare providers identify at-risk populations and implement preventive measures. Monitoring the prevalence of these cysts contributes to population health data, guiding resource allocation and healthcare utilization patterns. Quality measures may include tracking patient outcomes following treatment for conjunctival cysts.

Reimbursement & Billing Impact

Reimbursement may vary based on the payer and the specific treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate the need for surgical intervention. Coders should ensure that all relevant clinical notes, including the size and symptoms of the cysts, are included in the patient's medical record. Best practices include verifying coverage policies with payers and ensuring that all procedural codes align with the diagnosis.

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 H11.443?

H11.443 specifically covers bilateral conjunctival cysts, which are typically benign and may arise from various etiologies such as gland obstruction or irritation. It does not cover other conjunctival lesions like papillomas or neoplasms.

When should H11.443 be used instead of related codes?

H11.443 should be used when bilateral conjunctival cysts are diagnosed. If only one eye is affected, H11.442 should be used. Accurate coding is essential to reflect the clinical findings.

What documentation supports H11.443?

Documentation should include a detailed description of the cysts, their size, location, any associated symptoms, and the treatment plan. Photographic evidence may also be beneficial.