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ICD-10 Guide
ICD-10 CodesH16.069

H16.069

Billable

Mycotic corneal ulcer, unspecified eye

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

Code Description

ICD-10 H16.069 is a billable code used to indicate a diagnosis of mycotic corneal ulcer, unspecified eye.

Key Diagnostic Point:

Mycotic corneal ulcer, unspecified 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, tearing, and decreased vision. The cornea, which is the clear front surface of the eye, becomes compromised due to the infection, which can arise from various fungi, including filamentous fungi and yeasts. The disease progression can be rapid, leading to corneal scarring, perforation, and potential loss of vision if not treated promptly. Diagnostic considerations include a thorough history and physical examination, slit-lamp biomicroscopy, and corneal scraping for microbiological analysis. The involvement of the conjunctiva and sclera may also be assessed, as these structures can be affected in severe cases. Early identification and management are crucial to prevent complications and preserve vision.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires laboratory confirmation and differentiation from other types of corneal ulcers.
  • Treatment complexity: May involve antifungal medications, topical therapies, and possibly surgical intervention.
  • Documentation requirements: Detailed clinical notes and laboratory results are essential for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other corneal conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of the ulcer type or eye involved.
  • Documentation gaps: Incomplete clinical notes or lack of laboratory results.
  • Billing challenges: Potential denials due to insufficient evidence of medical necessity.

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 and vision. The condition is more prevalent in immunocompromised individuals and those with ocular surface disease. Understanding the epidemiology of fungal infections in the eye can help healthcare providers implement preventive measures and improve patient outcomes. Quality measures may include tracking the incidence of mycotic ulcers and the effectiveness of treatment protocols.

ICD-9 vs ICD-10

Mycotic corneal ulcers can significantly impact patient quality of life and vision. The condition is more prevalent in immunocompromised individuals and those with ocular surface disease. Understanding the epidemiology of fungal infections in the eye can help healthcare providers implement preventive measures and improve patient outcomes. Quality measures may include tracking the incidence of mycotic ulcers and the effectiveness of treatment protocols.

Reimbursement & Billing Impact

Reimbursement considerations include the need for detailed notes that justify the medical necessity of antifungal treatments or surgical interventions. Common denials may arise from insufficient documentation or failure to demonstrate the severity of the condition. Coders should ensure that all relevant clinical data is included in the claim to support the diagnosis and treatment plan.

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 H16.069?

H16.069 covers mycotic corneal ulcers that are not specified by laterality or specific fungal etiology. It includes cases where the fungal infection is confirmed but lacks detailed classification.

When should H16.069 be used instead of related codes?

H16.069 should be used when the specific eye affected is not documented or when the fungal type is unspecified. If the eye is specified, use H16.061 or H16.062 accordingly.

What documentation supports H16.069?

Documentation should include clinical findings, results from corneal scraping or cultures, treatment plans, and follow-up notes to support the diagnosis of a mycotic corneal ulcer.