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ICD-10 Guide
ICD-10 CodesH16.061

H16.061

Billable

Mycotic corneal ulcer, right eye

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

Code Description

ICD-10 H16.061 is a billable code used to indicate a diagnosis of mycotic corneal ulcer, right eye.

Key Diagnostic Point:

Mycotic corneal ulcer, specifically affecting the right eye, is a serious ocular condition characterized by the presence of fungal infection in the cornea, leading to ulceration. Clinically, patients may present with symptoms such as redness, pain, photophobia, tearing, and decreased vision. The anatomy involved primarily includes the cornea, which is the transparent front part of the eye, but may also affect adjacent structures like the conjunctiva and sclera. Disease progression can be rapid, with potential complications including corneal scarring, perforation, and even loss of vision if not treated promptly. Diagnostic considerations involve a thorough clinical examination, including slit-lamp biomicroscopy, and may require corneal scraping for microbiological analysis to identify the specific fungal organism. Timely diagnosis and intervention are crucial to prevent severe outcomes and preserve vision.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires specific laboratory tests to confirm fungal etiology.
  • Treatment complexity: Often involves antifungal medications and possibly surgical intervention.
  • Documentation requirements: Detailed clinical notes and diagnostic results are essential.
  • Coding specificity: Requires precise coding to differentiate from other types of corneal ulcers.

Audit Risk Factors

  • Common coding errors: Misidentifying the eye affected or the type of ulcer.
  • Documentation gaps: Incomplete clinical notes or lack of lab results.
  • Billing challenges: Denials may occur if documentation does not support the diagnosis.

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

Infectious Disease

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Mycotic corneal ulcers have significant clinical implications, as they can lead to vision loss if not promptly diagnosed and treated. The population health impact is notable, particularly in regions with high rates of fungal infections. Quality measures may include tracking the incidence of fungal keratitis and the effectiveness of treatment protocols. Healthcare utilization patterns may reflect increased visits to ophthalmology specialists and the need for advanced diagnostic testing, highlighting the importance of awareness and early intervention in managing this condition.

ICD-9 vs ICD-10

Mycotic corneal ulcers have significant clinical implications, as they can lead to vision loss if not promptly diagnosed and treated. The population health impact is notable, particularly in regions with high rates of fungal infections. Quality measures may include tracking the incidence of fungal keratitis and the effectiveness of treatment protocols. Healthcare utilization patterns may reflect increased visits to ophthalmology specialists and the need for advanced diagnostic testing, highlighting the importance of awareness and early intervention in managing this condition.

Reimbursement & Billing Impact

Reimbursement considerations include verifying the patient's insurance coverage for antifungal treatments and potential surgical interventions. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Adhering to coding best practices, such as using the most specific code available and ensuring accurate descriptions of the patient's condition, can help mitigate these challenges.

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 H16.061?

H16.061 specifically covers mycotic corneal ulcers caused by fungal infections in the right eye. This includes conditions such as fungal keratitis, which may arise from various fungi including Aspergillus and Fusarium species.

When should H16.061 be used instead of related codes?

H16.061 should be used when the diagnosis is confirmed as a mycotic corneal ulcer in the right eye, distinguishing it from other types of corneal ulcers or infections that may not be fungal in origin.

What documentation supports H16.061?

Documentation should include a comprehensive eye examination report, results from corneal scraping or cultures, treatment plans, and any imaging studies performed to support the diagnosis of a mycotic corneal ulcer.