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ICD-10 Guide
ICD-10 CodesH16.051

H16.051

Billable

Mooren's corneal ulcer, right eye

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

Code Description

ICD-10 H16.051 is a billable code used to indicate a diagnosis of mooren's corneal ulcer, right eye.

Key Diagnostic Point:

Mooren's corneal ulcer is a rare, painful condition characterized by a progressive, unilateral corneal ulceration that primarily affects the right eye in this case. Clinically, it presents with symptoms such as severe ocular pain, photophobia, tearing, and visual disturbances. The anatomy involved includes the cornea, which is the transparent front part of the eye, and may extend to the conjunctiva and sclera if left untreated. The disease is thought to be autoimmune in nature, leading to the destruction of corneal tissue. Progression can be rapid, resulting in significant corneal scarring and potential vision loss. Diagnostic considerations include a thorough ocular examination, slit-lamp biomicroscopy, and possibly corneal scraping or biopsy to rule out infectious causes. The differentiation from other corneal ulcers, such as those caused by infections or trauma, is crucial for appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassifying the ulcer as infectious rather than autoimmune.
  • Documentation gaps may arise if the clinical rationale for the diagnosis is not clearly articulated.
  • Billing challenges can occur if the treatment plan is not adequately supported by clinical findings.

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

Mooren's corneal ulcer has significant clinical implications, as it can lead to vision loss and decreased quality of life for affected individuals. The condition is rare, but its impact on population health is notable due to the potential for severe complications. Quality measures in ophthalmology often focus on timely diagnosis and effective management of corneal disorders, highlighting the importance of awareness and appropriate coding in healthcare utilization patterns.

ICD-9 vs ICD-10

Mooren's corneal ulcer has significant clinical implications, as it can lead to vision loss and decreased quality of life for affected individuals. The condition is rare, but its impact on population health is notable due to the potential for severe complications. Quality measures in ophthalmology often focus on timely diagnosis and effective management of corneal disorders, highlighting the importance of awareness and appropriate coding in healthcare utilization patterns.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of care, which may involve medications such as corticosteroids or surgical interventions. Common denials may arise from insufficient documentation of the diagnosis or treatment rationale. Best practices include ensuring that all clinical notes clearly outline the patient's symptoms, examination findings, and treatment decisions to support the coding and billing process.

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 H16.051?

H16.051 specifically covers Mooren's corneal ulcer affecting the right eye. It is characterized by a non-infectious, progressive corneal ulceration that may lead to significant ocular morbidity if not treated promptly.

When should H16.051 be used instead of related codes?

H16.051 should be used when the diagnosis is confirmed as Mooren's corneal ulcer in the right eye, distinguishing it from other corneal ulcers that may have infectious or traumatic origins.

What documentation supports H16.051?

Documentation should include a detailed ocular examination, evidence of corneal ulceration, and any relevant imaging or laboratory findings that support the diagnosis of Mooren's corneal ulcer.