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ICD-10 Guide
ICD-10 CodesH16.062

H16.062

Billable

Mycotic corneal ulcer, left eye

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

Code Description

ICD-10 H16.062 is a billable code used to indicate a diagnosis of mycotic corneal ulcer, left eye.

Key Diagnostic Point:

Mycotic corneal ulcer, left eye, is a serious ocular condition characterized by the presence of fungal infection leading to ulceration of the cornea. Clinically, patients may present with symptoms such as redness, pain, photophobia, and decreased vision in the affected eye. The anatomy involved primarily includes the cornea, which is the transparent front part of the eye, and can also affect adjacent structures such as the conjunctiva and sclera. The disease progression can be rapid, often leading to corneal scarring or perforation if not treated promptly. Diagnosis typically involves a thorough eye examination, including slit-lamp examination, and may require corneal scraping for microbiological culture to identify the specific fungal organism. Early diagnosis and intervention are crucial to prevent vision loss and complications. Treatment usually involves antifungal medications, and in severe cases, surgical intervention such as corneal transplantation may be necessary.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires identification of fungal pathogens and differentiation from bacterial or viral ulcers.
  • Treatment complexity: Involves antifungal therapy and potential surgical options.
  • Documentation requirements: Detailed clinical notes and diagnostic test results are essential.
  • Coding specificity: Requires precise coding to differentiate from other types of corneal ulcers.

Audit Risk Factors

  • Common coding errors: Misidentifying the type of corneal ulcer.
  • Documentation gaps: Incomplete clinical notes regarding the causative organism.
  • Billing challenges: Potential denials due to lack of supporting documentation for antifungal treatments.

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 can significantly impact patient quality of life due to pain and potential vision loss. They are more prevalent in immunocompromised populations and can lead to increased healthcare utilization, including emergency visits and surgical interventions. Understanding the epidemiology of fungal infections in the eye is crucial for public health initiatives aimed at prevention and early treatment, particularly in at-risk populations.

ICD-9 vs ICD-10

Mycotic corneal ulcers can significantly impact patient quality of life due to pain and potential vision loss. They are more prevalent in immunocompromised populations and can lead to increased healthcare utilization, including emergency visits and surgical interventions. Understanding the epidemiology of fungal infections in the eye is crucial for public health initiatives aimed at prevention and early treatment, particularly in at-risk populations.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity for antifungal medications and potential surgical interventions. Common denials may arise from insufficient documentation of the fungal etiology or lack of detailed clinical notes. Best practices include ensuring all clinical findings and treatment rationales are well-documented, and using appropriate modifiers when necessary to indicate the complexity of care 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 H16.062?

H16.062 specifically covers mycotic corneal ulcers caused by fungal infections, including those due to organisms such as Fusarium, Aspergillus, and Candida. It is important to differentiate this from bacterial and viral corneal ulcers, which are coded differently.

When should H16.062 be used instead of related codes?

H16.062 should be used when the diagnosis is confirmed as a mycotic corneal ulcer in the left eye, particularly when fungal etiology is established through culture or clinical presentation. It should not be used for non-fungal corneal ulcers.

What documentation supports H16.062?

Documentation should include a detailed clinical examination, results of corneal scraping or culture identifying the fungal organism, treatment plans, and any surgical interventions performed. This ensures accurate coding and supports medical necessity for treatments.