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ICD-10 Guide
ICD-10 CodesH16.13

H16.13

Non-billable

Photokeratitis

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

Code Description

ICD-10 H16.13 is a used to indicate a diagnosis of photokeratitis.

Key Diagnostic Point:

Photokeratitis, commonly known as 'snow blindness,' is an acute condition resulting from excessive exposure to ultraviolet (UV) light, particularly UV-B rays. It primarily affects the cornea, leading to inflammation and pain. Patients typically present with symptoms such as redness, tearing, photophobia, and a sensation of a foreign body in the eye. The cornea, being the most affected anatomical structure, undergoes changes that can lead to epithelial damage and, in severe cases, corneal edema. Disease progression is usually rapid, with symptoms appearing within hours of exposure and often resolving within 24 to 48 hours with appropriate care. Diagnostic considerations include a thorough history of UV exposure, clinical examination, and possibly fluorescein staining to assess corneal integrity. It is crucial to differentiate photokeratitis from other conjunctival and corneal disorders, such as conjunctivitis or corneal abrasions, to ensure proper management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other ocular conditions.
  • Treatment complexity: Management may involve topical analgesics and UV protection.
  • Documentation requirements: Detailed history of exposure and symptomatology needed.
  • Coding specificity: Accurate coding requires understanding of the condition's nuances.

Audit Risk Factors

  • Common coding errors: Misclassification with other corneal conditions.
  • Documentation gaps: Incomplete history of UV exposure.
  • Billing challenges: Potential denials if the condition is not well-documented.

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

Emergency Medicine

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Photokeratitis has significant clinical implications, particularly in populations exposed to high UV environments, such as skiers or outdoor workers. Understanding its epidemiology helps in developing preventive measures and public health initiatives. Quality measures may include patient education on UV protection and timely access to care. Healthcare utilization patterns indicate that increased awareness can lead to reduced incidence and better management of acute cases, ultimately improving patient outcomes.

ICD-9 vs ICD-10

Photokeratitis has significant clinical implications, particularly in populations exposed to high UV environments, such as skiers or outdoor workers. Understanding its epidemiology helps in developing preventive measures and public health initiatives. Quality measures may include patient education on UV protection and timely access to care. Healthcare utilization patterns indicate that increased awareness can lead to reduced incidence and better management of acute cases, ultimately improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Coders should ensure that all relevant clinical findings are documented, and that the treatment plan is clearly outlined to support the diagnosis. Best practices include using specific codes for the condition and maintaining thorough records to facilitate claims processing.

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 H16.13?

H16.13 specifically covers photokeratitis caused by UV light exposure. It does not include other forms of keratitis or corneal injuries not related to UV exposure.

When should H16.13 be used instead of related codes?

H16.13 should be used when the condition is specifically due to UV exposure, differentiating it from other keratitis codes that may arise from infectious or traumatic causes.

What documentation supports H16.13?

Documentation should include a detailed patient history of UV exposure, symptom description, clinical findings, and any treatments administered. This ensures accurate coding and appropriate reimbursement.