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ICD-10 Guide
ICD-10 CodesH16.073

H16.073

Billable

Perforated corneal ulcer, bilateral

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

Code Description

ICD-10 H16.073 is a billable code used to indicate a diagnosis of perforated corneal ulcer, bilateral.

Key Diagnostic Point:

H16.073 refers to a perforated corneal ulcer affecting both eyes, a serious ocular condition characterized by the erosion of the corneal epithelium leading to a full-thickness defect. Clinically, patients may present with severe eye pain, redness, photophobia, and decreased vision. The cornea, a transparent layer covering the front of the eye, plays a crucial role in focusing light and protecting internal structures. The progression of a corneal ulcer can lead to perforation, which may result in the leakage of intraocular contents, potentially leading to endophthalmitis or loss of the eye if not treated promptly. Diagnostic considerations include a thorough ocular examination, slit-lamp biomicroscopy, and possibly cultures to identify infectious agents. The anterior segment of the eye, including the cornea, conjunctiva, and sclera, is involved in this condition, making it essential for healthcare providers to understand the anatomy and pathology to ensure accurate diagnosis and treatment.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

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

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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

The clinical significance of H16.073 is profound, as perforated corneal ulcers can lead to severe vision loss and complications such as endophthalmitis. The population health impact is notable, particularly in regions with high rates of ocular infections or trauma. Quality measures may include timely intervention and management of corneal ulcers to prevent perforation. Understanding healthcare utilization patterns related to this condition can help in developing preventive strategies and improving patient outcomes.

ICD-9 vs ICD-10

The clinical significance of H16.073 is profound, as perforated corneal ulcers can lead to severe vision loss and complications such as endophthalmitis. The population health impact is notable, particularly in regions with high rates of ocular infections or trauma. Quality measures may include timely intervention and management of corneal ulcers to prevent perforation. Understanding healthcare utilization patterns related to this condition can help in developing preventive strategies and improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures performed. It is essential to ensure that all relevant clinical information is included in the medical record to support the coding and billing process, as well as to adhere to payer-specific guidelines for reimbursement.

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 H16.073?

H16.073 covers bilateral perforated corneal ulcers, which may arise from various etiologies including infectious keratitis, chemical burns, or trauma. It is crucial to differentiate this condition from non-perforated ulcers and other corneal diseases.

When should H16.073 be used instead of related codes?

H16.073 should be used when both eyes are affected by a perforated corneal ulcer. If only one eye is involved, the appropriate unilateral code (H16.071 or H16.072) should be selected based on the affected side.

What documentation supports H16.073?

Documentation must include a detailed ocular examination, evidence of perforation, treatment plans, and any imaging or laboratory results that support the diagnosis of bilateral corneal ulcers.