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ICD-10 Guide
ICD-10 CodesH11.81

H11.81

Non-billable

Pseudopterygium of conjunctiva

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

Code Description

ICD-10 H11.81 is a used to indicate a diagnosis of pseudopterygium of conjunctiva.

Key Diagnostic Point:

Pseudopterygium of the conjunctiva is a condition characterized by a fibrovascular membrane that extends from the conjunctiva onto the cornea, resembling a pterygium but lacking the typical features of true pterygium. Clinically, patients may present with symptoms such as redness, irritation, and visual disturbances due to the encroachment of the membrane on the corneal surface. The anatomy involved includes the conjunctiva, which is the clear membrane covering the white part of the eye, and the cornea, the transparent front part of the eye. Disease progression can vary; while some cases remain stable, others may lead to significant visual impairment if the pseudopterygium grows extensively. Diagnostic considerations include a thorough ocular examination, where the clinician assesses the extent of the membrane and its impact on visual acuity. Differential diagnoses may include true pterygium, conjunctival cysts, and other conjunctival lesions, necessitating careful evaluation to ensure appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other conjunctival and corneal conditions.
  • Treatment complexity: May involve surgical intervention if vision is affected.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis.
  • Coding specificity: Requires precise coding to distinguish from similar conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with true pterygium or other conjunctival disorders.
  • Documentation gaps: Incomplete clinical notes may lead to denials.
  • Billing challenges: Variability in reimbursement for surgical versus non-surgical management.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Pseudopterygium can significantly affect patient quality of life, leading to discomfort and potential visual impairment. Understanding its prevalence and impact on population health is crucial for healthcare providers. Effective management and coding can improve healthcare utilization patterns, ensuring that patients receive appropriate care. Epidemiologically, awareness of pseudopterygium can aid in early detection and intervention, ultimately enhancing patient outcomes.

ICD-9 vs ICD-10

Pseudopterygium can significantly affect patient quality of life, leading to discomfort and potential visual impairment. Understanding its prevalence and impact on population health is crucial for healthcare providers. Effective management and coding can improve healthcare utilization patterns, ensuring that patients receive appropriate care. Epidemiologically, awareness of pseudopterygium can aid in early detection and intervention, ultimately enhancing patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear clinical notes that outline the patient's symptoms and the extent of the pseudopterygium. Common denials may arise from insufficient documentation or misclassification of the condition. It is essential to follow coding best practices, ensuring that the diagnosis is supported by comprehensive clinical evidence and that any procedures performed are accurately coded to reflect the services provided.

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 H11.81?

H11.81 specifically covers pseudopterygium of the conjunctiva, which is characterized by a fibrovascular growth that may mimic pterygium but does not have the same underlying pathology. It is important to differentiate it from true pterygium and other conjunctival lesions.

When should H11.81 be used instead of related codes?

H11.81 should be used when the clinical presentation is consistent with pseudopterygium, particularly when there is a fibrovascular membrane extending onto the cornea without the features of a true pterygium. Accurate diagnosis is crucial for appropriate coding.

What documentation supports H11.81?

Documentation for H11.81 should include a detailed ocular examination report, noting the characteristics of the conjunctival growth, any symptoms reported by the patient, and the impact on visual acuity. Photographic evidence may also be beneficial.