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ICD-10 Guide
ICD-10 CodesH11.811

H11.811

Billable

Pseudopterygium of conjunctiva, right eye

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

Code Description

ICD-10 H11.811 is a billable code used to indicate a diagnosis of pseudopterygium of conjunctiva, right eye.

Key Diagnostic Point:

Pseudopterygium of the conjunctiva in the right eye is characterized by a fibrovascular growth that extends from the conjunctiva onto the cornea, resembling a pterygium but lacking the true tissue characteristics of one. Clinically, patients may present with symptoms such as redness, irritation, and visual disturbances due to the encroachment of the growth on the corneal surface. The conjunctiva, sclera, and cornea are the primary anatomical structures involved, with the pseudopterygium typically arising from chronic irritation or inflammation, often associated with environmental factors such as UV exposure or chronic dry eye. Disease progression can lead to increased discomfort and potential visual impairment if the growth progresses significantly. Diagnostic considerations include a thorough ocular examination, where the growth's characteristics are assessed, and differential diagnoses are made to rule out true pterygium or other conjunctival lesions. A slit-lamp examination is essential for evaluating the extent of the lesion and its impact on the cornea and surrounding tissues.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from true pterygium and other conjunctival disorders.
  • Treatment complexity: May involve surgical intervention if symptomatic or visually impairing.
  • Documentation requirements: Detailed clinical notes and imaging may be necessary to support diagnosis.
  • Coding specificity: Specific to the right eye and requires accurate coding to avoid errors.

Audit Risk Factors

  • Common coding errors: Misidentification as true pterygium or incorrect laterality.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and examination findings.
  • Billing challenges: Potential denials if the necessity of treatment is not well-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

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 patients' quality of life, leading to discomfort and potential visual impairment. Understanding its prevalence and management is essential for improving population health outcomes. Effective coding and documentation can enhance healthcare utilization patterns, ensuring that patients receive appropriate care and resources for this condition.

ICD-9 vs ICD-10

Pseudopterygium can significantly affect patients' quality of life, leading to discomfort and potential visual impairment. Understanding its prevalence and management is essential for improving population health outcomes. Effective coding and documentation can enhance healthcare utilization patterns, ensuring that patients receive appropriate care and resources for this condition.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of surgical intervention if the pseudopterygium is symptomatic or affecting vision. Common denials may arise from insufficient documentation of the condition's impact on the patient's quality of life or visual acuity. It is crucial to ensure that all clinical notes are comprehensive and that the coding accurately reflects the diagnosis and treatment 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 H11.811?

H11.811 specifically covers pseudopterygium of the conjunctiva in the right eye, which may arise from chronic irritation or inflammation. It is important to differentiate it from true pterygium and other conjunctival lesions.

When should H11.811 be used instead of related codes?

H11.811 should be used when the diagnosis is specifically a pseudopterygium in the right eye, and it is essential to document the clinical findings that support this diagnosis to differentiate it from other conjunctival conditions.

What documentation supports H11.811?

Documentation should include a detailed ocular examination report, noting the characteristics of the pseudopterygium, symptoms experienced by the patient, and any relevant history of eye conditions or environmental exposures.