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ICD-10 Guide
ICD-10 CodesH11.812

H11.812

Billable

Pseudopterygium of conjunctiva, left eye

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

Code Description

ICD-10 H11.812 is a billable code used to indicate a diagnosis of pseudopterygium of conjunctiva, left eye.

Key Diagnostic Point:

Pseudopterygium of the conjunctiva in the left eye is 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 thin membrane covering the white part of the eye, and the cornea, the clear front surface 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. Accurate diagnosis is crucial for determining the appropriate management strategy, which may involve observation, topical medications, or surgical intervention if the pseudopterygium affects vision significantly.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from true pterygium and other conjunctival disorders.
  • Treatment complexity: Management may vary from conservative to surgical approaches.
  • Documentation requirements: Detailed clinical findings and treatment rationale must be documented.
  • Coding specificity: Requires precise coding to reflect the specific condition and affected eye.

Audit Risk Factors

  • Common coding errors: Misclassification with true pterygium codes.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and treatment.
  • Billing challenges: Potential denials if the condition 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

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 crucial for improving population health outcomes. Effective treatment can reduce healthcare utilization by preventing complications that may arise from untreated cases, such as corneal scarring or astigmatism. Awareness of this condition among healthcare providers can enhance early diagnosis and intervention, ultimately improving patient care.

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 crucial for improving population health outcomes. Effective treatment can reduce healthcare utilization by preventing complications that may arise from untreated cases, such as corneal scarring or astigmatism. Awareness of this condition among healthcare providers can enhance early diagnosis and intervention, ultimately improving patient care.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for ophthalmic procedures and ensuring that claims are submitted with the correct modifiers when surgical intervention is performed. Common denials may arise from insufficient documentation or misclassification of the condition, so it is essential to adhere to coding best practices and maintain clear communication with payers.

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 H11.812?

H11.812 specifically covers pseudopterygium of the conjunctiva in the left eye, which is a benign growth that may mimic a true pterygium but lacks the same pathological characteristics.

When should H11.812 be used instead of related codes?

H11.812 should be used when the condition is specifically diagnosed as pseudopterygium in the left eye, differentiating it from true pterygium or other conjunctival disorders.

What documentation supports H11.812?

Documentation should include a detailed ocular examination, noting the characteristics of the conjunctival growth, any associated symptoms, and the impact on visual acuity.